Passion

A few days ago I watched "The Business of Being Born." I heard about this documentary a little over a year ago on a c-section mom's forum. I had no intention of ever seeing it because so many fellow c-section moms seemed to have some issues with it. When it popped up on the list of recommended videos for my Lamaze training, I decided I would watch.

I can't say how I would have reacted before I had done some of my reading, but I must say, I have no idea why everyone on the forum was upset about it. There was one comment in the entire film that bothered me, but the rest of the information just made sense. The film was produced by Ricki Lake after she had some negative feelings about the birth of her first child. There is a lot of good information comparing the United States to other developed nations. While we are a proud group of people, I think it might be worth taking a look at some other countries with better birth outcomes.

There are many things I didn't know and have been surprised by. A doctor in the film who worked with the World Health Organization stated that of the 7 most developed nations (which I believe are Canada, Japan, Italy, France, United Kingdom, Germany and the United States), the US has the worst infant mortality rate. I had no idea. In many of these other countries, a majority of the births occur at home with a midwife.

If you take a look at the history of birth, it almost always happened at home. Around 1900, the wealthy started to birth with doctors in hospitals. Over time, this became the norm. Women went from birthing in a squatting position to birthing on their backs because it was easier for a doctor to see what was going on. It is important to note that hospital births were not any better than a home birth. In fact, they were probably worse. There was more risk of infection in a hospital, a place for sick people. Over the past 100 years, many things changed such as better sanitation and public health. The maternal and infant mortality rates improved. Around the 1930's, doctors began using "twilight sleep" to remove a birthing mother's memory of the birth. It was a medical issue, attended by a doctor. Women were alone for much of the labor and often restrained due to the effects of the medications administered.

Beginning around the 1950's, doctors began to want to control birth to a further degree. They began using induction, skewing the number of births occurring Monday through Friday, 9 to 5. With the use of pitocin, they could be home for dinner with their families. Time limits were imposed and many still exist as hospital policy. If your water breaks, most hospital will require you to be delivered in 24 hours, even if mother and baby are doing fine. The reasoning for this is increased risk of infection. If we didn't do so many vaginal exams, there would be less risk for infection. If left a little longer, most labors will begin and progress on their own.

Inductions double or triple your chances of a cesarean. When you are induced, you are tethered to a number of machines. Your babies heart rate will be monitored continuously, you will have an IV for the pitocin and probably a blood pressure cuff taking readings automatically every 15 minutes or so. This decreases your ability to move around during labor. Movement helps in pain relief as it helps the baby to ease down into the birth canal with gravity. Pitocin is a synthetic version of oxytocin, which is what your body makes in a natural labor. Oxytocin reaches your brain and triggers the release of endorphins which is your bodies own natural pain relief. Pitocin does not reach your brain, so those endorphins are not released, making it more likely you'll want an epidural to manage the pain. Being monitored continuously also makes it more likely that a "problem" with the babies heart rate will be detected and the baby will be labeled "in fetal distress." Studies have shown that continuous monitoring is not only not helpful during labor, it may lead to unnecessary interventions and vacuum assisted or cesarean birth.

So why is all of this being done? There are a slew of reasons. Obstetricians are trained to deal with high risk births. All women are treated with pretty much the same standard of care, when in fact, 80% of those women do not need the interventions used. Some of this is due to simply going with the flow, going with hospital policy, etc. Much of this is due to convenience, although the obstetrician may not necessarily realize that is what is motivating some of their decision making. As many people know, most of these policies are due to possible legal action in the event of a catastrophic event during birth. A c-section will always look like you intervened at an appropriate time and "saved the day." It's a safe choice for the obstetrician. Let me take the time to say that I don't blame individual doctors, but the system they practice in. Too much policy is driven by the possibility of a lawsuit. With malpractice insurance premiums costing some obstetricians six-figures a year, it's not surprising that they will avoid a lawsuit whenever possible.

While this seems like a lot of information, I assure you there is much more out there. Midwifery is evidence based. Obstetricians are not using all of the evidence to provide the best birth outcomes. The are very good doctors with very important skill, but they do not need to be handling all births as if they are high risk.

I am still at the very beginning of my study, but am surprised about how passionate I am about educating women about the evidence. I don't know how, but I would love to work to change the system and help make routine interventions not quite as routine. I have more information now then when I was pregnant. That raises another important question: how do we make women aware of all of the information available? I know personally, I would have made different choices my first time around. Choices I didn't know I had.

Again, birth is a very personal choice and there is no right or wrong way. This is information that is helpful in making informed decisions about your birth choices. I will spend some time focusing on cesarean births, specifically elective cesareans. I do not wish to judge any one's childbirth choices.