Medicalized Birth


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.”

When doc treats your baby like cake,
Remember, there’s too much at stake–
Lungs and brain need to grow
And they let you know
So insist you need more time to bake!

 

Inspired (as much as limericks are ever “inspired”) by the information about brain development in the last few weeks of pregnancy found in this excellent Mother’s Advocate post about labor induction, as well as research indicating that the surfactant produced in baby’s lungs to prepare for breathing may be a primary trigger for labor.


Please feel free to share, post, or print.  Credit appreciated, but not required (just don’t pretend you wrote it, or the plagiarism goblins will come and steal your firstborn).

Bonding with your baby doesn’t have to be difficult, strained, confusing, or scary.  Instead, it can be primitive–and I mean that in the deepest, most physical, empowering, irresistible sense.

When a baby is born, he is still a primitive being.  He doesn’t have the ability to make rational choices about where he centers his love.  Meanwhile, his neurochemistry is making connections and setting baselines that can have lifelong effects, and the way he is treated at and following birth has direct effects on that neurochemistry.  In fact, we know that babies (and not just newborns, but older babies as well) who receive minimal touch from their mothers often fail to thrive.  We could speculate about why that is, but really, it’s irrelevant.  The point is that we cannot explain to a baby why she is alone in a mechanical warmer with goop in her eyes, with skin pricked painfully, instead of snuggling that skin against the only sense of security she has ever known.  So if we cannot calm her with reason, then the only way to give her the neurological support that she needs is never to remove her from the arms of her mother to begin with.  And just in case we ever doubted that in her mother’s arms is her rightful place, a baby in skin-to-skin contact after birth breathes better, has better temperature and heart rate regulation, and will usually find the breast on her own.

On the other side of this new relationship, the grown woman tends not to be so primitive; indeed, many of us think that our primitive side is something shameful.  But the primitive is a valuable part of the whole of being human, and when we suppress it instead of integrating it, we also suppress valuable resources and abilities.

Certainly the ability to override the physical is an amazing skill that allows a woman to overcome a traumatic birth to bond with her baby, or even to bond with an adopted baby.  But when we take it for granted that a mother will use her powers of reason to bond with her baby no matter how much we abuse their relationship, we ignore the way the emotional, physical, and spiritual sides of ourselves participate in the birth and bonding process.  Pregnancy and labor involve neurochemical and physical changes that make it easier for us to be mothers, and that emotional and hormonal dance does not end with labor.  This is why the sixth Lamaze Healthy Birth Care Practice is “Keep Mother and Baby Together–It’s Best for Mother, Baby, and Breastfeeding.”  If we are willing to let it do its part, the same primitive source of knowledge involved in conceiving and growing a baby provides valuable instincts and hormonal reactions for not only bonding with that baby, but also caring for him.

To put it another way, the fact that people can overcome losing a leg doesn’t justify removing legs for less than life-saving reasons.  Just because a mother can find ways to bond that are not the original primitive bonding that occurs in the first hours after birth, doesn’t mean that it is ethical to deprive her of that important and very physical part of being a mother, nor to deprive her of the advantages of having a baby who has been able to bond normally.  Whenever it is possible to preserve someone’s own leg, it is most humane to do so.  Whenever it is possible to keep mother and baby together–and this can actually have even more advantages with preemies and after a cesarean–that is the most humane course of action.  We no longer expect a woman to overcome a lack of physical attraction and hormonal chemistry to marry as her parents see fit, so why do we expect mothers to forgo a deeply physical attachment to their babies?  Those “primitive” bonds function at the deepest levels of our minds.  Let’s take full advantage of the opportunity to access those unconscious abilities!

©NZBA

You’ve probably seen the warnings on cigarettes: “SURGEON GENERAL’S WARNING: Smoking By Pregnant Women May Result in Fetal Injury, Premature Birth, And Low Birth Weight.”

Perhaps a nearly identical warning would be appropriate at the front desk of every OB office or L&D ward: “SURGEON GENERAL’S WARNING: Scheduled Delivery May Result in Fetal Injury, Premature Birth, And Low Birth Weight.”

A recent article on Fit Pregnancy talks about an insurance company that told their providers to “curb the practice” of scheduling deliveries after they “found that 48 percent of newborns admitted to the NICU were from scheduled deliveries, many of them before 39 weeks.”  Lo and behold, they “saw a 46 percent decline in NICU admissions in just three months.”

So I have an idea: let’s save those NICU beds for the babies who really need them, and let the healthy babies stay inside the healthy mamas just as long as they need to stay.  An estimated due date is just that, an estimate–not an expiration date.  Not every baby walks at 12 months exactly; some are ready sooner, and some later, and the only way we know is to see them do it. Not every adult male is exactly 170 pounds, and the only way we know how big our sons are going to grow is to watch them do it.

In other words, parenting is about patience.  Let’s remind our care providers that our parenting starts with pregnancy, and not every baby is ready to be born at 40 weeks (much less 39 or 38), or at 8 pounds (much less the 7 or 6 pounds that a third-trimester ultrasound “measurement” of 8 pounds can mean).  In fact, let’s review those two often-stated reasons for induction: “overdue” baby, and “big” baby.

“You’re OVERDUE!” Remember, no medical practitioner should consider a baby “overdue” until 42 weeks.  Recommending induction the moment you’ve gone past your “due date,” or some even earlier arbitrary “safe” delivery date, arrogantly assumes that the practitioner knows better when your baby is ready to breathe than nature or God does (depending on your own point of view).  And since induction creates additional risks for mother and baby, early induction without urgent medical reason is not only arrogant, it’s impatiently irresponsible.

If you’ve gone past 42 weeks and would still like to avoid unnecessary induction, especially if you have any doubt of your conception date or have a family history of healthy babies waiting until past 42 weeks to be born, you can do your research and then work with your practitioner on using expectant management and monitoring YOUR particular situation rather than working from statistics that may or may not apply to you and your baby.

“Your baby is getting BIG!” Isn’t “Let’s just go ahead and induce/schedule a c-section” really saying “Let’s just go ahead and deliver your baby prematurely”?  If low birth weight is a dangerous side effect of smoking, let’s stop giving credence to the idea that iatrogenic low birth weight is optimal for ease of birth or for baby’s health.  Scheduling a delivery at 38 weeks for a “big” baby is just as foolhardy as scheduling that early delivery for a baby who’s measuring 6 pounds.  We simply do not know how big that baby needs to get–and more importantly, how long her lungs and brain need to develop–until labor begins on its own.  (Research for mothers with diabetes, especially gestational diabetes, seems to be inconclusive, which to my mind means expectant management is still a wise option.)  And with mother-friendly care during labor and during birth, a 10- or 11-pound baby born vaginally is more than possible, it’s NORMAL.

For instance, I’m 5’4″, 125 pounds not pregnant, and I delivered a 9-pound 6-ounce baby at 40 weeks.  If the average growth rate is a quarter to half a pound a week during the last weeks, that means he hit that dreaded 8 pounds somewhere between 34 and 37 weeks.  Let me tell you, the “extra work” of pushing another couple of pounds of baby fat into the world was well worth having a baby who was ready to breathe on his own, nurse effectively, and maintain his own temperature as well as any newborn can.  (The question of whether bigger necessarily means harder to deliver is a topic for another post.)  I know at least three women whose babies were premature due to unavoidable circumstances and who spent weeks visiting their babies in the NICU.  I think they would agree with me that there is nothing “convenient” about a premature baby struggling to adjust to the outside world.  Don’t put yourself in their position voluntarily, and don’t let a pushy doctor put you and your baby there just for the false “convenience” of a scheduled delivery or a smaller baby.