How often have you heard these kinds of statements from women or care providers?

  1. A lot of women can’t dilate all the way.”
  2. Placentas don’t come out on their own.”
  3. “You can’t have a baby without pain medication.”
  4. “We have to break your water.”
  5. “The cord was around the neck, so we had to cut it right away.”
  6. “She needed a cesarean because she wasn’t making enough progress.”
  7. “Lots of women can’t breastfeed.”
  8. “We have to induce or your baby is going to be too big to birth vaginally.”
  9. “Once a cesarean, always a cesarean.”
  10. “My body just doesn’t go into labor.”

The ultimate source of this anti-birth, anti-evidence bull hockey is a topic for another post (or book, such as Ronnie Davis-Floyd’s insightful anthropology-based Birth as an American Rite of Passage).  But I do want to point out the self-reinforcing nature of these obstetrical ideas that have no basis in scientific evidence, nor even common sense.

Take, for example, the OB quoted on My OB Said What?!?: “It’s SO weird that you’re in labor! I haven’t had a mom go into spontaneous labor in over a year!”  In other words, this physician schedules inductions so routinely–and so early–that he or she almost never lets a baby grow to full term.  (Iatrogenic prematurity is also a topic for another post, but let’s at least remember here that gestational age estimates can be off by two weeks or more, and that late preterm infants are at risk for severe complications at birth and in the long term.)  Since this OB almost never sees women going into spontaneous labor, his practice of routine induction is self-reinforcing.  After a while it becomes easy to forget that women and babies are designed to go into labor on their own; and with almost no normal experiences for comparison, it also becomes easy to ignore the risks to which routine induction exposes these clients.  This may be an extreme case, but with more than one in five labors in the U.S. being induced as of 2006, induction is clearly a norm for many care providers.

If you re-phrase the list of quotes above, it turns out that we hear this kind of circular self-reinforcing thought process all the time:

  1. “I expect cervixes to dilate on a specific schedule, and if they don’t, they must not be able to dilate.”
  2. “I don’t wait for the placenta to come out on its own; I’ve never seen a placenta come out on its own.”
  3. “I don’t supported unmedicated births; I’ve never seen an unmedicated birth.”
  4. “I almost never see a mother’s water break on its own; I always perform artificial rupture of membranes at 4 centimeters.”
  5. “I always cut the cord on the perineum; I’ve never seen a baby with a nuchal cord deliver normally.”
  6. “The average labor (under a care model that labels a long labor as dysfunctional and intervenes accordingly) is 12 hours; since she wasn’t pushing by 12 hours, she needed a cesarean.”
  7. “I don’t see much point in taking the time to support breastfeeding; I don’t see many women breastfeed successfully.”
  8. “I’ve never seen a baby over nine pounds born vaginally; I always induce if I think a baby is getting big; I require my patients to birth on their backs.”
  9. “Once a cesarean, always a cesarean.”
  10. “Your baby is not going to come on her own; I don’t wait past 40 weeks.”

These self-reinforcing habits of thought and practice not only help many physicans avoid learning about evidence-based medicine (and I’m not trying to be snarky here; learning is hard work, and doctors are just as prone to intellectual stagnation as the rest of us), but they also affect the beliefs of birthing women.  It doesn’t help that when a quarter of our countrywomen have inductions and a third have cesareans, major medical interventions in birth seem normal.

Which leads us to the biggie, the overarching self-reinforcing assumption of the disease model/interventive medical model of birth: “You need to be in the hospital/have continuous electronic monitoring/[insert intervention here] because labors fail and babies go into distress all the time.”  The prevailing culture and media constantly barrage us with the message that birth is is a disaster waiting to happen, and that birth emergencies are sudden and common.  And that message is reinforced every time the normal process of labor is hijacked by medical intervention, because it’s not the intervention that gets questioned when the assumption is already in place that birth and the female body are the faulty parts of the situation.

So what’s a thinking pregnant mama to do?  First, find a care provider who practices evidence-based care, respects your decision-making autonomy, and will offer you the support that is so important for success in goals like natural birth and exclusive breastfeeding. (CIMS’ Ten Questions is a good way to start your interviews.)  Consider hiring a doula for continuous labor support and initial breastfeeding support.  And find a network of people who will support you as you create your own messages:

  1. “I’m a normal, healthy woman and my cervix will dilate in its own time.”
  2. “The birth process works best and is healthiest when every stage proceeds on its own time frame.”
  3. “I cannot give myself stronger contractions than I can handle.”
  4. “Intact membranes make a good cushion for baby and help protect us both from infection.  It even used to be good luck for a baby to be born ‘in the caul.'”
  5. About a quarter of babies carry their cord safely with them around the neck.”
  6. “My labor will progress in the timeframe that’s needed by my body and my baby.”
  7. “Breastfeeding is natural and normal.  Most women’s bodies are able to make enough milk to support one or more babies.”
  8. “My body will not grow a baby too big to birth.  By growing my baby to natural term, I’m protecting him until his body is ready to breathe, nurse, and keep itself warm.”
  9. “VBAC is a safe, healthy option and not only gives this baby the benefits of labor, but also prevents compounded complications from multiple cesareans.”
  10. “My body knew how to perform the miracle of making this baby from almost nothing; of course it knows how to go into labor when my baby is ready to be born.”