Birth

I had the privilege and pleasure to spend my day yesterday with over a hundred women from all walks of life, from all over the state of Ohio and surrounding states and from all different age ranges. The one thing we all share is a passion for birth, more importantly, safe birth for all women. I was surrounded by the most incredible women in birth. Ina May Gaskin, midwife and author of Spiritual Midwifery and Ina May’s Guide to Childbirth. Jackie Gruer, a CNM from Cincinnati who owned a free standing birth center where she attended births in addition to in the hospital and at home, until she was forced out of practice by unaffordable malpractice costs. JoAnne Davis, a CNM and PhDc who has attended home and hospital births and recently did a study entitled “Midwives’ Perceptions of Normalcy” that was so powerful and moving, I was brought to tears at times and I was not alone. I ate dinner with four beautiful CNMs from Ohio, only one of which is currently practicing as a CNM.

The day was full of laughter, love, anger, frustration, tears, revelations and hope. Every woman there believes, above all else, birth has to be safe. We believe in a woman’s ability to birth her baby and we believe in the appropriate use of modern technology such as cesarean birth. We fully recognize cesareans to be life saving for mothers and babies and not a single woman who was at this conference believes we should have a 0% cesarean birth rate. We also don’t believe we should have a 30.2% cesarean rate either; this is not safe for anyone.

In 1970 the US cesarean rate was 5.5%. In 2005 the cesarean rate sky rocketed to 30.2%. Some will argue that we have saved lives and birth is far safer today than it has ever been. Yes, many lives have been saved by the appropriate use of cesareans, no one argues this. The question, however, is how many lives have been hurt by the misuse of cesareans? In 1982, 7 out of every 100,000 women died in childbirth. As of 2003, 12.3 out of every 100,000 died in childbirth and, sadly, the CDC recognizes this number to be incorrect. They estimate the actual maternal mortality rate to be 1.3 to 3 times higher. Wondering how this can be possible? Reporting of maternal deaths in the US is done via an honor system; there are no penalties for misreporting or failing to report maternal deaths.

Cesareans are not the only factor in the rise of maternal mortality. Drugs used off label to induce labors, such as cytotec, play a role as well. These drugs have dangerous side effects that can lead to complications in both mother and baby. So why do we use them? If these things are so dangerous to moms and babies, why would a room full of doctors cheer at someone yelling “Next year, we’ll have a 100% cesarean rate!”? Unfortunately, there is no easy answer. Some believe money is a big factor. Others feel it is about control and power.

I don’t know what the answer is or even if we need one. What I do know is this: things need to change. We have a “pathological fear” when it comes to birth. Birth is mysterious and we are told horror stories from many women around us. Women no longer trust in their ability to birth, they fear it. When we birth, we let our brains drive; we need to put our brains in the back seat and let our bodies drive. Women need to know what to be scared of and it isn’t birth! We need to look at our fears and examine the aspects that scare us and what we can do about them. Will there still be cesarean births? Yes! Again, I am in no way saying there should be a 0% cesarean rate; there are reasons to have a cesarean, it can be life saving and sometimes the only way a baby can safely be born or a woman can safely birth. Rather, I am saying that perhaps we should not be so casual about cesarean birth.

There is often debate among women when it comes to birth. Some feel that people who birthed naturally should be applauded by all. Others feel that those who had epidurals are smart and those who didn’t want one are crazy. Some feel like failures if they didn’t have a certain type of birth. Many women feel judged by others about their birth. We need to realize something; there is no right or wrong way to birth. It really doesn’t matter how a woman births as long as she is respected and is given the ability to make informed choices. The judging and debating each other has to stop, it serves no one but doctors. If we are busy judging others and arguing with each other about who had a better birth, how will we have energy to question them?

There are some women asking questions and trying to make change, but it will take more. What would happen if we stopped putting all our energy into judging and/or debating each other or feeling guilty about our birth and, instead, used that energy to ask questions and demand evidenced based care? We are the richest country in the world yet only one other developed country has a higher maternal mortality rate than we do, this is a problem! Something needs to change. Women, babies and families are being hurt both physically and emotionally. We need to work together to bring forth progress, to make changes.

Women will not be alone in our quest for change. There are OBs who refuse to do unnecessary cesareans and have to go to a different hospital because they won’t fulfill a cesarean rate quota (http://birthnewsblog.blogspot.com/2005/06/doctor-wont-make-cut.html). Some are even loosing their license to practice due to having a low cesarean rate (http://millinersdream.blogspot.com/2005/10/youre-fired.html).

Where do we start? Education is key. But how do we teach women to trust in their body’s ability to give birth and teach them that there are exceptions but those exceptions are in no way failures? We can teach women ways to maximize the possibility of vaginal birth according to Ina May:

· Low sounds

· Humor for pain relief

· The recognition of the sexuality of birth helps

· Rope pulling aids descent

· Slow crowning

· The Sphincter Law rules

o Sphincters don’t obey orders

o Sphincters function best in atmospheres of intimacy and privacy

o Sphincters may suddenly close when intimacy, privacy or trust are violated

o Sphincters open most effectively when mouth and jaw are open and relaxed

· It is safe to eat and drink

· “Apple-shaking” helps

· Orgasms happen

Other things to remember, according to Ina May, are:

· When it hurts—smile!

· Relaxed mouth and throat=relaxed bottom

· Intimacy is needed in birth

Thinking I am crazy for some of these things? Ina May had us try something, you try it too and you’ll understand. Tighten your perineum; squeeze it as hard as you can. Now smile big! What happened? Were you able to keep your perineum tight while smiling? Probably not. We need to have a relaxed face in order to have a relaxed perineum. Think about toddlers who are filling their diapers. We can tell they are pooping because they have this relaxed, semi smile on their face. We need to do the same thing in birth.

We also need to celebrate birth, all birth! Tell women your favorite part of birth and don’t scare them! Tell them about the first time you heard your baby make a sound or you got to look into his eyes. What it was like to touch this being you just brought into the world for the first time. To look at him and smell his sweet baby smell. The more women hear how horrible birth is, the more they will dread and fear it. On the flip side, the more women hear others speak about birth in a positive way the more they will look forward to it. And if a birth didn’t go well, let a mom be sad or angry or happy. Ask her about the good parts of her birth and let her talk about the ugly ones too.

I end this with hope and fear. Fear that some people will not understand my passion or feel that I believe birth has to be a certain way. I don’t believe in a certain way of birthing, there is no such thing as normal birth, there is only birth. My hope is that all birthing women will know how incredible they are for bringing a baby into this world. My hope is that one day all birthing woman and all birth will be celebrated, respected and honored.