Childbirth issues

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.