Childbirth issues

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Like Smockmomma, I am grieved that so many young women today are disinterested in preparing for the upcoming birth of their children – but I am even more grieved that so many of them have opted for “Birth American Style” as portrayed on TLC’s The Baby Story. It seems that they honestly expect the time from first contraction to the actual birth to be 15 minutes or so (the interval on most episodes of Baby Story). And, many of them ‘just know’ that they will ‘need’ induction, epidural anesthesia, a cesarean or whatever – before they even get to term!
I’ve been involved in the childbirth movement since I don’t know when. My first exposure was in various novels – I remember reading birth scenes in books as far removed as Michener’s Hawaii and Sterne’s Tristram Shandy. I vaguely remember reading about the caudal (an early form of epidural anesthesia) in some Reader’s Digest Condensed book around the age of 8 or 9. As the oldest child in a large family, I was very familiar with the idea of pregnancy as a part of life – even though my mom was critically ill during her third pregnancy and was hospitalized for several weeks before and after giving birth, she still had 3 more children after that.

The first book specifically about birthing babies that I remember reading was Grantly Dick Read’s Natural Childbirth. I was terribly impressed with his faith in the essential normalness of childbirth, coupled with a watchful waiting. He seemed to me to balance faith and action. 2 decades later, when I had the chance to see film of Dr. Dick Read in action, his faith in God was clearly evident. In High School, I read Marjorie Karmel’s Thank you Dr.Lamaze – and once again was impressed that childbirth is a challenge but not an ordeal for the majority of women who are properly prepared.
When I was pregnant (in 1974) with my first child at the age of 19, I read my way through two public libraries and my Lamaze teacher’s private library. My teacher also kept copies of birth reports from all her students, clippings from magazine and newspaper articles, and I read all of these that she made available. I watched every film and TV program that I could find on the topic of birth and babies. My husband and I practiced relaxation and breathing techniques faithfully.
I may have been a bit more obsessive than some ( I think that even then God was preparing me to become a midwife) – but the majority of us having babies in the 1970s took some kind of childbirth class and wanted to have an experience of birth that was not only medically safe but emotionally satisfying as well. Most of us ended up with big or little disappointments, because our preparation for childbirth did not prepare us for reality. Our reactions to that disappointment took some radically different forms. Because I was coerced into having pain medication that I did not want, did not need, and to which my daughter had side effects, I became a gung-ho natural childbirth advocate. I switched from the moderate Lamaze method to the militant Bradley method for my second child. That birth was unmedicated, for which I was grateful, but I was still greatly disrespected by the nurses at the hospital, to the point where my doctor almost didn’t make it for the birth (due to their not believing what I was telling them). I chose to have my next 2 children at home. (I returned to the hospital for my last 2 children – AFTER the hospitals made midwifery care available).
My philosophy of care is basically that childbirth and pregnancy work most of the time. This is how God made us. There are potential problems and complications, and the job of the midwife or other care provider is to be attentive and ready to intervene appropriately, but to keep hands off if things are going OK. I see myself as a lifeguard or tour guide. It can be very tempting to see myself as the savior, but there is really only one true Savior – don’t we all agree on that? I can interpret just about any childbirth situation to make it seem that my heroic actions saved mother and child, but in reality very few births end up that way – and many of those we end up rescuing moms and babies from dangers into which we had put them through our attempts to rescue them from something else. (This is known as the cascade of interventions. For example, a woman chooses an elective induction of labor for reasons that seem good to her, and her provider agrees. Labor is forced on a body and baby that is not quite prepared, and the contractions are so strong that the baby and/or mom cannot tolerate them. The mom gets an epidural, the baby gets distressed, the mom can’t move around to help correct the situation, the baby can’t get into the right position in the pelvis because the epidural has paralyzed some of the mom’s muscles, the mom doesn’t dilate quickly enough, the baby can’t tolerate the contractions needed to effect delivery, and you end up with either cesarean, forceps, vacuum or whatever).
The history of obstetrics and midwifery is peppered with good intentions. An intervention or technology is developed to deal with a particular problem. It seems to be effective for that one situation, and is then applied to other situations. It may turn out to be less effective or even harmful for the other situations, but the habit and/or fashion has developed to use the technique even so. Finally, after years or decades or even centuries, the true value of lack thereof is elucidated, and the technique then takes its rightful place. vast majority of interventions into the essentially normal process of parturition end up being abandoned or greatly modified in the long run. Forceps are a great example of this – the birth scene in the opening chapters of Tristram Shandy is truly a classic. Forceps started out as a way to deliver a live baby through a contracted pelvis – and eventually became the fashionable way to give birth, at great cost to generations of women and children. Having studied history, I tend to have a greatly skeptical view of most interventions, while recognizing that there are always exceptional circumstances that call for exceptional actions.
It is clear to me that many of the current fashions and fads in childbirth are very harmful to mothers and children. The industrialized countries with better maternal and infant outcomes have structures that protect against some of the worst faddism by relegating normal childbirth to experts in the normal, while having a clear and easy way to obtain specialist care for the abnormal cases. The Netherlands provides midwifery care and home births to those for whom it is appropriate, thereby saving the resources of intensive care for those women and children who need it . England also uses midwives in hospital and at home – and as a matter of fact, only trained midwives provide any maternity care in hospital (even if these midwives do not all actually attend the births). Surgeon/gynecologists are only involved with births that need surgery. Most countries with better outcomes than the USA also have much lower rates of Cesareans – and that may be a contributing factor. Death in childbirth, while low overall in the USA, is still 7 to 17 times more likely after a cesarean than after a normal birth.
There are some areas where some sort of intervention is clearly needed if one has any hope of mother and child both surviving childbirth reasonably intact, if at all. Obstructed labor is a classic one. The labor can be obstructed do to a variety of reasons – and in about 2% of these cases, a cesarean is indeed necessary. A baby that presents a shoulder or a hipbone rather than the head or the buttocks, for example, is not going to be able to negotiate any but the most generous of pelvises. A baby that needs to be delivered through the placenta is at great risk of dying in the process and of taking along his mother. A baby grown abnormally large due to maternal diabetes or other problems, or a mother with pelvis contractures from rickets, malnutrition, dwarfism, or trauma may not be able to deliver even a small baby in perfect position.
However, cord around the neck is such a common finding that in and of itself it is probably totally meaningless. Even a cord with one, two, or three true knots in it does not necessarily compromise the baby or obstruct the labor. This is because, if the placenta is healthy, the force of the blood whooshing through the cord prevents it from collapsing . Think about a garden hose. It takes a lot of force to kink it when the water is going full blast. The major reason cord around the neck causes problems is that it effectively shortens the cord so that it pulls on the placenta as the baby is coming through the birth canal – then you can get into real trouble real fast, especially if the bag of waters is artificially broken to try to speed things along.
Anyhow, I have rambled on here for quite a while. If you are interested in more detail on any of my ramblings, or if you want the names of some books to read on this and other related topics, please ask me as specifically as possible.


Thanks for the wonderful post. I am new to the blogging thing and I end up forgetting a lot of what I want to post. You made so many good points.

I am blessed to have had a mother who like you was way ahead of her time on the birth scene. I was born in 1977 and my mom switched Doctors at 8 months along because the Doctor she had was unwilling to let her birth in a natural way. She ended up having me in the only hospital in her town that would allow my Dad to be in the room with her. I have four younger brothers and besides my brother who is only 18 months younger than me, I was able to be there for all the others births. Two were at home and the final was in the hospital. I was 17 at the time and remeber vividly how wonderful it was to have the whole family and some friends there in attendance.
Well, I could go on and on so maybe I'll do a follow up post on our blog. It's always nice to find someone else who knows what goes on with our modern medical practice regarding childbirth.

Speaking of fictional birth scenes, my favorite was in Morning Glory by LaVyrle Spencer. Preparing for the birth was a minor subplot of the book, so I really can't describe it briefly. If you get a chance to look for it, you might enjoy it.

I watch those baby shows on Discovery and TLC because I am addicted to babies. I also heckle them, however, causing my children to peer in every once in a while with frowns on their faces.

Not every woman can have a "perfect" delivery, and goodness knows that none of mine were textbook perfect. The problem I see and mourn and scream at is the fact that women are setting themselves up for complications by their attitude towards pain relief. Labor is painful. Oh, yeah, I had three 9 lb+ babies naturally, I got the pain part down. But when you accept an epidural early in labor, you are setting the stage for more interventions. Maybe not every time . . . but often enough that we need to wake up to the fact that pain in labor can be managed in other ways beyond numbing the mother's body from the abdomen down.

There was one episode of one of those baby shows, I think it was on TLC . . . there was an 18 year old or so primapara who did not accept any pain medication. She had her mother there to support her, and she seemed to be doing pretty well considering. Yes, she howled and moaned and was in a great deal of pain . . . but in a hushed undertone, the narrator and the narration focused on a "how long can she take it" attitude. The unspoken assumption was that this girl was obviously a moron for not having an epidural. The camera lingered on her face as she groaned . . . .

But after a long period of pushing, she delivered a healthy baby . . . and she was suddenly radiant and pain-free. Her baby didn't have any compromised breathing due to pain medications and was alert and perky. It was a good outcome . . . one that should be "normal" instead of the rare exception. I think the fear of pain has grown into a monster.

I was induced with my last child, mainly because I was a week over-due, it was late June, and I was ready to do darn near anything to get this child OUT. He'd dropped into position a week before. *Seriously* dropped, as in his little head was already engaged, I was 90% effaced and 5cm dilated for the last week. After just breaking the waters didn't start labor, they gave me Pitocin . . . and I swear the nurses did not know what to do with a woman who refused an epidural. Confusion, especially when I insisted on being able to walk to the bathroom by myself. "But . . . ." But nothing. It's not like he had very far to go! In the end, it only took three hours after they started the Pitocin for him to make his appearance, 9 pounds, 5 ounces, and all the hair worn off the top of his head so that he looked like a tonsured little monk.

I ended up having a shot of something, I forget what it was. Not Demerol, but similarly sleep-inducing. If I had had someone with me in the labor and delivery room, I probably would have been able to handle the labor without it, but being alone was stressful, so I started having anxiety attacks. Which leads me into my long-standing belief about labor . . . good labor and delivery nurses are God-sends, but all too rare and always running two or three other labors at the same time. Doulas and nurse-midwives should be standard practice, because the laboring woman needs someone knowledgeable there with her, and there is not always a mother or involved spouse who is able to do so. (My husband was caring for our other children.)

Fear and pain are closely linked . . . we need to remove the fear from the birthing process somehow. Otherwise, millions of otherwise healthy and capable mothers will end up having traumatic interventions that could have been prevented. I'm not talking about true emergencies . . . I'm talking about those poor women who get an epidural when they're only 1cm dilated, who end up strapped to a bed and fail to progress, and end up having a c-section when the baby starts to get stressed. Those sorts of things don't need to happen.

Thank you for sharing your experiences and your insight, Alicia. I, too, am a proponent of the Read-Bradley method. When I was first studying about childbirth, I wondered why it took so long to figure out something I thought was just common sense -- the whole fear cycle thing. I mean, hellooo?
I think my only unanswered question is this: What do you think of doulas? Rather, where do you stand on the doula debate?
I will say this, I am extremely private during labor. I don't want anyone save my spouse with me. Period. Over and Out. It was only after much prayer that my husband and I decided to hire one. Well, she was there for the birth of my fourth child and I think she was a complete godsend. She was an incredible presence. I cannot even explain it; words fail me. I just remember thinking how blessed I was to have my spouse, my doctor, and my doula all on *my* side. It was very comforting.

I had the epi at 2 cm. I was induced and had had maybe 1/2 hour of sleep, but my husband was plenty sleepy, and they told me it would help me sleep. Actually this was about 2 1/2 hours after I woke up with pain (not terrible) and I finally gave in. The baby never got stressed, the doctor just said I "should have dilated 1 cm an hour" and a bunch of other nonsense. Ugh. Aside from sin the course of that birth is about the biggest regret of my life. As a result I am now someone who has a toddler but hopes to give birth for the first time in the future.

Oh, it didn't help me sleep, either. And they had given me an Ambien earlier and the general tone was one of impatience with me for being quite alert at the thought that I was expected to have a baby within the next day or so.

The epi didn't take away all the pain and you know what? I'm so glad I have that much of an idea what labor was like.

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This page contains a single entry by alicia published on November 17, 2003 3:43 PM.

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