Here I go, opening my big mouth.

When I started learning more about natural childbirth and midwifery care, I wondered why this was all news to me. Why did people who believe a natural approach to birth is better than a medical approach not talk about it more? While I can’t speak for everyone else, I think there are a few reasons I’ve been a little tight lipped about it. Firstly, I don’t want to seem like a ‘single-issue-voter’: someone that people see coming and run because, “oh, there’s Kim, she’s going to corner me and try to sell me on natural birth again.” I believe it’s important, but I’m not going to shove it down your throat. Secondly, I don’t want to have to defend myself. My head is swimming with so much information about the benefits of natural vs. medical births, but I’m not an expert, and I don’t want to feel backed into a corner and like I have to defend my choices. I know I’m making the best decision I can, but I don’t expect myself to be able to consistently express my thoughts about it clearly. Along with that, I guess I feel like if someone wants to confront me about anything, I need to be able to WIN!

Ultimately, I do believe that birth is a normal life event. It’s something that women ought to experience, not be delivered from. It’s something a woman does, not something that happens to her. If you’re not sick, you don’t need a doctor, and pregnancy is not an illness.

What about midwives? Don’t they all wear Birkenstocks, have long hair, smell like incense, and show up to catch your baby without so much as a pair of gloves? Crazy hippies. I’ll admit, that’s not far off from what I assumed midwives were until I started educating myself. The truth is that midwives are experts when it comes to normal, uncomplicated pregnancy and birth – which is most pregnancies and births. And I haven’t yet met one who looks like the one in my mind. They’ll be the first to admit that there is surely a need for good obstetricians, but not nearly the need we have perceived in this culture. Statistics show that there are many countries whose maternal and newborn mortality rates are far lower than ours, with midwife attended birth rates far higher than ours. Midwives know what they’re doing. They’ve been attending births since the beginning of time (okay let’s not get technical here – I’m aware there would have been no midwife when Eve gave birth to Cain, but you catch my drift), while doctors are the ones who are new to the scene. And dare I say, they’re not proving to be very good at normal birth. They are good at making normal birth complicated, if you can call that being good at something…

Anyway, I am happily, joyfully, and expectantly preparing for the birth of this sweet little one who will, Lord willing, be entering this world in less than two months. There is such a difference in my heart and mind as I prepare to welcome our baby in the peace and quiet of our own home, with my husband by my side, an encouraging midwife team who trusts the design of a woman’s body to do as it was created to do, with the sights and smells I am familiar with… without those horrible hospital gowns – and the smell that goes along with them.

4 Responses to “Here I go, opening my big mouth.”

  1. Becky Fehr Says:

    Lovely:)

    I think your reason for not talking about it more was one of my reasons. I love my birth stories and love sharing them, when others want to hear. It doesn’t make me happy to tell someone who feels forced into hearing.

    I am thrilled that options like midwives are easier to get in our province now! So many more options are easily available then when I started nine years ago. It is wonderful to see. Sometime we should chat soon and I can share with you the measures my man and I went to do it natural and our way. This is such a wonderful part of life!

    I am so excited for you and totally believe, as you do, that this isn’t an illness it is something WE CAN DO as women! You go for it KIM! Many blessings to you and your team:)

  2. JM Says:

    Hi Kim,

    Thanks for the post. I think I’ll weigh in and offer a few comments. I apologise in advance for the length of this response.

    I agree with you on several points. I’m a huge fan of midwives and am thrilled that the registered midwifery program in SK is expanding. You’re absolutely right—midwives are experts when it comes to normal uncomplicated pregnancy, delivery, and post-partum care. (And, yes, that represents the majority of situations). They have significant training and skills after having completed their four-year program. They are less expensive on the healthcare system and often are able to spend much time with their patients as compared to physicians. You are right, there are some well-designed studies (e.g. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2742137/) that have suggested that for uncomplicated pregnancies, “planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and adverse maternal outcomes compared with planned hospital birth attended by a midwife or physician.”

    Okay, now a little bit of friendly push-back:

    1) Whenever I hear someone talk about their affection for “natural childbirth,” I want to know what they mean by “natural.” I think the term “natural” is somewhat fluid and fluctuates as times change. For instance, the treated, cleansed water supplied to the homes and hospitals of Saskatoon is not natural. It is water that has been tinkered with by modern science. Many countries are more “natural” (i.e. no access to clean drinking water), and the outcomes are devastating. Your home birth will take place in a home that is heated through the product of modern, Western, scientific means. A wood-burning stove is more “natural,” but it can have unwanted consequences. I see many young children from the north with asthma that is poorly controlled because their houses are heated by wood-burning stoves. I could go on. But I think you get my point. There are many things that we probably don’t regard as “unnatural” when they are.

    2) The reported maternal mortality ratio in Canada has declined from approximately 500 maternal deaths per 100,000 live births in the early 1920s to less than 5 per 100,000 live births in the 1990s. Much of this decline is undeniably due to advances in obstetrical care and greater access to health care.

    3) The midwives of today cannot be compared to the midwives of yesteryear. As I mentioned above, today’s midwives are highly trained in modern medicine. They are equipped to deal with obstetrical emergencies such as post-partum hemorrhage with modern pharmacologic agents.

    4) There is a huge difference between doulas and midwives. That’s something important to remember.

    5) The supposed antagonism between midwives and obstetricians is often overinflated by proponents of natural childbirth. There is an ever-increasing collegiality and cooperation between midwives and obstetricians. I just attended an obstetrics course put on by the Society of Obstetricians and Gynecologists of Canada, and some of the committee members and instructors were midwives. Nearly 1/3 of the course participants were midwives—happy to learn from the obstetricians, family physicians, and fellow midwives.

    6) You need to be careful at interpreting some statistics touted by the natural childbirth enthusiasts. Just because there are fewer negative outcomes in a group of patients cared for by midwives as compared to a group of patients cared for by obstetricians does not necessarily mean that the obstetricians provide worse care. Midwives usually do not deal with high-risk pregnancies. The sheer fact that obstetricians often deal with sicker, high-risk patients means that they will likely have more worse outcomes. Correlation does not necessarily equal causation! Many more people die in hospitals than die in shopping malls, but it’s not the hospitals that kill them—it’s the fact that hospitals are filled with sick people. There is a 100% correlation between eating pickles and death, but eating a pickle is seldom the cause of death. People die because they are people.

    7) Yes, there has been a tendency for physicians to over-investigate and over-intervene in the last century, but the pendulum is really shifting. It’s physicians themselves who are conducting the studies that point the fingers at themselves and allow everyone else to point fingers at them. We are constantly self-evaluating and trying to improve. This is a direct quote from the ALARM course I attended put on by the Society of Obstetricians and Gynecologists of Canada: “Labour management supports the physiologic process of birth while identifying potential concerns. It allows interventions that will increase the likelihood of a vaginal birth. Promotion of normal birth involves a balance between non-intervention and the judicious use of technologies that support safer outcomes for mother and baby.”

    8) You talk about the “design of a woman’s body” doing what it “was created to do.” Yes, the female body is structured to give birth (mine isn’t, and I’m glad!). However, when compared to many other species, it is not as easy for humans to give birth. As a species, we are in a tension between wanting big brains and wanting to walk on two feet. The bigger the brain, the bigger the head. And walking on two feet comes at a price of reduced pelvic dimensions. Consequently, we can tend to need more help getting our big heads through our small pelvises. Just ask the thousands of poor, young, African women with obstetrical fistulas.

    Okay, I’ve rambled enough.

  3. Kim Says:

    James, thanks for the comment. I really appreciate you bringing up the things you did. I agree with all your “friendly pushback” and am glad to have the voice of a clear-headed friend to remind me to look at facts and think with my head, not only my emotions on some of these things. I trust people to do research for me, and appreciate the statistics you brought up, as well as reminding me how to interpret them. There’s a reason your the one completing a medicine residency, and not me :)

  4. JM Says:

    I should probably add a couple clarifying remarks:

    1) When I said, “The midwives of today cannot be compared to the midwives of yesteryear,” I didn’t mean to single out midwives. I’ll happily concede that the physicians of today cannot be compared to the physicians of yesteryear. Physicians have a checkered past of bloodletting, trephination, and other scary stuff that was more metaphysics than physics. Many professions have improved dramatically because of advances in modern science. I mentioned midwives specifically because Kim referred to the historical role midwives have played.

    2) When I said, “There is a huge difference between doulas and midwives,” I was not implying that doulas do not have a valuable role to play. A meta-analysis of 16 trials involving over 13,000 women showed that women who had continuous intrapartum support were likely to have a slightly shorter labour, more likely to have a spontaneous vaginal birth, and less likely to have intrapartum analgesia or to report dissatisfaction with their childbirth experience. Doulas and other support persons can play a very helpful role in enhancing normal labour processes and reducing the need for obstetrical intervention. However, the role of a doula is much narrower in scope than that of a midwife.

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