Giving Birth With Confidence

Here in the heart of Ann Arbor, Michigan, the police are on the prowl for speeding drivers. The patrol cars hide behind bridges and in alleyways to surprise those of us who might go 30 in a 25 mph zone. This morning, as I was dutifully creeping along at 20 miles an hour my husband joked, “You know, they’ve won. You now have the cop within you.” This week’s TIME.com piece on elective C-section describes that same process: letting fear set up a place in us that controls us much more than we’re aware of.

Take the article’s opening: a child psychiatrist who made her mind up to have a surgical birth long before she met her husband. She’d watched some traumatic hospital births in medical school and had internalized (probably from hearing it over and over) the story of her mother’s emergency C-section. “I had a fear…” is how she summed things up. That fear-cop within her had scared her enough to risk unnecessary surgery and hand her birth over to someone else.

The piece goes on to say that better anesthesia and antibiotics are making surgical birth safer, and if I were her reading that, the fear-cop would be a little stunned and shouting, “What do you mean safer? You mean surgical birth isn’t safer already?”

Alas, as Gene Declercq wonders, maybe childbirth has lost its magic, its star quality — surrendered to the fear-police who have us convinced that we can’t care for our bodies as well as someone or something else can, that we’ve come to a place in human existence where our bodies aren’t up to the business of it all, that we need those machines that go “Ping!”, that we can no longer do birth as we were designed to. Our better nutrition and hygiene and knowledge have failed to empower us. Instead we’re afraid to enter into the everyday miracle of normal birth.

You must visit the U.K. Breastfeed: Be a Star website. On the home page a beautiful, glamorous woman is nursing her baby. On one side of them, the words “She’s Not a Pop Idol, She’s a Star” and on the other side, ”Breastfeed: Be a Star“.

The Be a Star campaign is dedicated to increasing the number of young mothers in Lancashire, Enland who choose to breastfeed. “We hope to do this by showcasing the beauty, confidence and pride that comes with breastfeeding, as well as providing breastfeeding information and support and highlighting the unique health benefits that it brings to both baby and mum”.

I love this campaign. The message? Breastfeeding is not drudgery. Breastfeeding mothers are special, attractive, even glamorous. This is marketing breastfeeding in a powerful, hard to resist way. Campaigns to increase breastfeeding rates that focus on the benefits of breastfeeding for mother and baby, or the risks of not breastfeeding have been only marginally effective. This creative, fun campaign gets across all the same information but let’s women know that choosing to breastfeed lifts them to a whole new place: stardom. Truth in advertising at its best!

Right on the heels of Rikki Lake’s documentary The Business of Being Born Debra Pascali-Bonaro is about to begin screenings across the world of her new documentary, Orgasmic Birth. I had a chance for a sneak preview several weeks ago. In many ways it’s a perfect sequel to the Lake documentary. This exquisite film gives us a chance to listen to women as they share their stories and their births and it lets us in on what Debra refers to as the “secret” that birth can be pleasurable, blissful, ecstatic, even orgasmic.

What unfolds, gently and beautifully, is the story of the sensuality of the experience of labor and birth. Most, although not all, of the births are at home. That’s not suprising. The privacy and the emotional safety that are necessary for peak sensual experiences are easier to come by in your own home than in an unfamiliar environment being cared for by strangers. If ’seeing is believing’, get ready to believe. Over and over we see real women working in labor but also being “in the zone”. The ecstasy on the women’s faces at the births can’t be faked. It’s real and I am increasingly convinced is meant to be a natural part of birth for women.

Debra and Robin Weiss talk about the documentary on Robin’s website. Check it out. Best of all on May 16 in honor of Mothers Day Orgasmic Birth will be featured on 20/20! They are planning to use some clips from the film, interview some of the women/couples in the film, Dr. Christiane Northrup and Ina May Gaskin two of the “experts” in the documentary and they also interested in talking with a few other women who have had “orgasmic” births.

Stay tuned for more information on how to arrange for a screening and how to get a copy of this incredible film for yourself.

My daughter passed along the news last week that Discovery Health has a program, House of Babies. Shari Daniels and the Miami Maternity Service are highlighted. This is the “Baby Story” we want: midwives and midwifery students who trust birth and women’s ability to give birth. Birth stories that show the power and wisdom of women, the magic and wonder of babies, and the safety of giving birth undisturbed and confident. I haven’t seen all the episodes but the ones I have seen testify to the good things that are happening at the Miami Maternity Center. House of Babies is a welcome change from the fear generating standard fare dished out by most of the network programming around birth. Could things be changing?

Not a chance. The March of Dimes announced the arrival of another Discovery Health program. “Discovery Health’s new six-part docu-series, DELIVER ME, follows the careers and lives of three dynamic women—best friends who became partners in a demanding Los Angeles OB/GYN practice.  In addition to their thriving careers, all three are mothers themselves, meaning each must juggle the pressures of delivering their patients’ children with those of raising their own. This is a show about juggling the demands of work and family”. And it’s about complex pregnancies and high risk births. Dramatic fare! The first episode was March 4 and there hasn’t been a normal birth yet. All cesareans. Even the woman whose breech baby turned before labor began decided on the cesarean anyway.

Check out the Lamaze Media Forum and get information about how to let Discovery Health know what you think of the two programs. And spread the word to the women you know that House of Babies shares the birth stories that women deserve to hear.

I’ve been wanting to share this story for a while. Tracy Donegan, author, doula, and Irish birth activist, alerted us that in Ireland one of the largest hospitals in Dublin is informing women that if their birth plans include avoiding medication in labor there is “no going back”. You say you don’t want medication? You are not, under any circumstance going to get it. The rationale? “Women in labor are not of ’sound mind’ therefore are incapable of making informed decisions.” Really?

It’s taken me several months of reflection to try to sort this one out. I admit I am no further along than I was back in November when we heard from Tracy. Men and women make hard decisions on a fairly regular basis when we are stressed, angry, overwhelmed, and, yes, even when we are in pain (physical and emotional). In each of these circumstances our feelings influence our decisions (certainly) but to suggest that we are not “of sound mind” and our decisions are therefore not informed decisions and should not to be honored is insane.

To follow the logic of that Dublin hospital, a woman would also not be capable of giving consent for a cesarean. Not only would she be in pain but she is likely to distressed that the surgery is necessary or even that her baby is at risk. What about the thousands of women each day in the US who, in the throes of working hard to manage their labors, are encouraged to take an epidural? I’ve never heard anyone say these women are not of “sound mind” although they are most definitely in pain.

Hospitals don’t like birth plans. They don’t want women to be knowledgeable. They want women to be compliant. The message is clear. “We know what is best for you. If you try to challenge this (with your birth plan) we will make things very difficult for you.” 

Women are completely able to make informed decisions in labor no matter how that labor is going. Unless she is comatose she has the right, the responsibility, and the ability to make decisions about her baby and her own care…including asking for medication if that is necessary. The only ones not of “sound mind” in Ireland are the hospitals that are trying to keep women from making and using birth plans.

Newsweek magazine’s Feb. 20, 2008 issue contains yet another succinct piece on choices that lie before today’s pregnant woman, the vast sea of information she has to sort through in making decisions about how to have her baby, where, and with who’s help, alongside all the other (sometimes frightening, sometimes inaccurate) stuff found online and from books, friends, and family. Writers Barbara Kantrowitz and Pat Wingert talk about how things have changed since their adult sons were born, the biggest case in point being the alarming rise in the rate of surgical birth in the U.S. They provide a mini-primer on today’s birthing options, from obstetrician/hospital birth to certified professional midwife/home birth.

Things really have gotten more and more confusing for women in the birth arena. The movies continue to paint labor and birth as AN EMERGENCY! In this season’s charming little film “Juno,” the otherwise laid-back family shifts into manic mode and comes flying out the front door and into the running car in a panic when the heroine’s labor begins. Movie doctors and nurses still gather around the bedside urging the sweating, white-knuckled, wide-eyed mother to “Push! Push!” These kinds of images make the natural/normal route of gentle birth appear less and less believable. That kind of drama makes us categorize birth as illness, something we need to step in the way of and fix. It’s (mis)information that leads us to the negative “what if’s” that prevent a woman from trusting her body.

Add in recent ACOG statements condemning families who choose home birth and painting CPMs as something akin to outlaw birth attendants. I’m no feminist, but this feels like yet another wrestling match with the professionals who should be in dialogue with us, learning from us, respecting and protecting women’s choices, some of which include home birth. It harkens back to the early 1900s when doctors mounted an attack of mis-information on midwives, almost wiping out the profession for a time by spreading a gospel of fear among pregnant women.

Fortunately, I got a good Rx for this kind of gloom-and-doom ranting after spending some time with my lovely friend and her new baby last week. Because of previous uterine surgery, she’d asked several OBs and midwives for advice on laboring. All agreed that in her case, surgical birth would be her only option. She knew what that kind of surgery felt like, and she went full stead ahead preparing for her baby’s arrival — surrounding herself with good, confidence-building reading material, eating well, resting, exercising.

I was able to be with the little family soon after post-op and am pleased to report that this Minneapolis hospital got it right. Within an hour after all the stitching up, baby August was resting his cheek on his mama’s breast in their room. He was never out of his father’s sight, always close enough to touch and comfort and hold in post-op, and thereafter was most often in his mom’s arms. When I suggested we might not give this sweet-smelling newborn a bath, all agreed, and the nurse kept August swaddled while she gently cleaned the bloody residue from his little head so that his visiting step-brother wouldn’t worry. The staff respected their breast-feeding wishes and gently helped get things established.

Three days later the family headed home where the mom set about to heal up her abdomen while getting used to her nursing body and the baby boy at her breast. I was relieved and encouraged by her discernment, her doctor’s follow-through with her patient’s requests, the gentle care this one hospital provided a family who for a time was adrift in that sea of birth information.

Australian scientist Dr. Mark Cregan is known for having discovered that human breast milk contains stem cells, a potentially rich mine to harvest for treatment of Parkinson’s, diabetes, and many other diseases. But wait, there’s more. His research is pointing to revelations about the potency of breast milk, not only that it meets all of a baby’s nutritional needs, but that it marks the body’s pathway toward development into adulthood.

ScienceNetwork reports that this molecular biologist is finding that a new mother’s mammary glands actually take over for the placenta to help guide the baby’s genetic destiny. So in addition to the IQ advantage and health benefits for infants we now know are linked to nursing, a sort of biological insurance plan is set up in breast milk in those early months that follows this little person into adult life.

Cregan says that manufactured infant formula may look the same as breast milk, but it can’t provide that developmental guidance that mother’s milk produces for her unique offspring. What a grand design is a woman’s body.

The decision to give birth at home is not influenced by fashion, by what’s trendy, or the latest cause celebre, contrary to what the American College of Obstetricians and Gynecologists latest press release on home birth suggests. ACOG believes that press coverage of an extremely well done documentary on our broken maternity care system highlights a fashionable trend rather than a serious problem. Ricki Lake’s documentary, The Business of Being Born, has opened the eyes of millions of Americans to the problems with maternity care in the US, to the seriousness of the problem, and to the value and safety of giving birth outside the current maternity care system.

Serious, intelligent women are saying “no” to maternity care that, contrary to what obstetricians and hospitals would lead us to believe, actually increases risk and danger for mother and baby.  Women who choose to give birth at home are making their decisions based on best evidence. If you need to be convinced visit the Cochrane Library, or read A Guide to Effective Care in Pregnancy and Childbirth, or read our book. The Childbirth Connection response to the 2006 ACOG policy statement on home birth is also important  reading.

The Cochrane review has not been updated since 1998. At that time there was only one study reviewed and that had a small sample. In spite of that, the recommendation was, and continues to be, that healthy women should not be advised against home birth. That recommendation is based on two realities: there is no evidence (and there never has been) that hospital birth is safer than planned home birth; and, there is no evidence that planned home birth is not as safe as hospital birth.  In 2005 a large study of home birth was published in the British Medical Journal. The study meets all the standards for scientific rigor. The research findings? For a healthy woman having a normal pregnancy, a planned, midwife attended home birth is as safe as a hospital birth and with far lower rates of medical interventions (that bring their own short and long term dangers).

It’s time for obstetricians and hospitals to pay attention to the research not just on the safety of home birth, but to the danger they place women and their babies in every day by providing maternity care that routinely interferes with women’s ability to give birth simply and easily. It’s time for obstetricians (and hospitals) to promote, protect and support normal birth in a serious way.  It’s also well past time for obstetricians to provide care that reflects best evidence, including supporting the value and safety of home birth.

The inside of my kitchen cupboard is where I stick clippings that I’ll get around to doing something with someday. Alas, I just went to hang one up for this summer’s gardening plans and in the jumble of it all ran across a little October piece from the Times – “Purposely Breaking Water Does Not Speed Delivery.”

It’s not breaking news (so to speak) that the amniotomy has been around for a couple of centuries. Plenty of birth attendants are still recommending to laboring women that breaking their membranes will speed things up. (The suggestion may very well be made to one of them while you are reading this sentence.)

The Cochrane Reviews report that breaking a woman’s water in labor may increase her chance of having a surgical birth. The lead author in the study advised laboring women to request their waters be left alone. Old news or new, a woman’s body can be trusted to give birth without our “help,” our poking, prodding, breaking something to speed things along.

While that recent American Journal of Obstetrics and Gynecology study tells us that not as many women are asking for surgical birth as we were hearing, the Swedes are telling us in the British Journal of Obstetrics and Gynecology that those who are requesting C-sections for no clinical reason are doing so out of fear. There’s that word – tokophobia: a pathological fear of giving birth. Making choices out of a basis of fear is never a good reason or a good place to begin.

The disconnect for me is how “safety” and “birth” and “surgery” have gotten tangled together in so many modern women’s minds. (Yes, there are those rare times when surgical birth is indicated. But the World Health Organization tells us that most of the world’s women can and should experience uncomplicated, normal birth.) So how can women be so confused as to think that major surgery on their bodies is safer for their baby and for them? Might those high numbers of babies in distress who land in newborn intensive care units across the country be linked to higher rates of surgical birth? And shouldn’t those increased rates of infection and hemorrhage in women who’ve undergone surgical birth make us consider that normal birth might be a better choice over surgery? There is no fear to be had in what we know is good about normal birth, from the important work that labor does on the baby’s lungs; to the benefits for getting breastfeeding established between mother and newborn; to the ease of healing in a woman’s body post-birth.

So pregnancy, rather than a time of celebrating a woman’s strength and confidence and ability, becomes yet another thing in our modern world to fear. Women trapped by their fear of the birth experience grow less confident, less happy, more afraid for their babies and for themselves. Being afraid, being very afraid when it comes to birth is not logical, helpful, or normal.