Clarity is an elusive beast.

James raised a number of really good points when he commented on my last post. For those of you who don’t know James, he’s a friend of ours who is studying medicine and is currently completing his residency. For the record, I’m not against doctors, and I’m certainly not against James! I deeply respect his opinion, and admire what he does day in and day out. His comment made it clear to me that I need to make my thoughts more clear :) So allow me to try to clarify some things.

When I talk about natural childbirth, I’m not talking about being out in nature without modern conveniences. James rightly pointed out that my home is supplied with clean water thanks to modern science. My home is heated thanks to modern science as well. I’m not trudging to a well to fetch my water with a bucket and heating my home with a wood burning stove – and for that I am thankful. I know there are many things I take for granted that make a home birth safer than it would have been in the distant past because they are, by a critical standard, unnatural.

I realize that doctors and obstetricians are necessary. A small percentage of pregnancies and births really are high risk, and really do require medical intervention. A skilled obstetrician is a gift from God that can provide expert knowledge and care when emergencies arise. I’m not trying to imply a war between midwives and medical professionals, as if their goals are polar opposite. I see both as having the well being of women and babies as the end goal. I think it would be a marvelous thing indeed if we could see more of midwives and physicians working together to that end. If there were more midwives in this country to deal with normal, uncomplicated pregnancies and births, it would free the doctors up to do more of what they do best – dealing with high-risk and complicated cases. I don’t see hospitals and doctors as the enemy of all that is good where birth is concerned. I’m also not saying that you can’t have a natural birth if you are in a hospital.

When I first started considering the idea of having a baby at home, Clay was dead-set against it. What if something goes wrong? He began to be won over when he learned how capable and qualified modern midwives are. These women have gone to school for four years to be trained to do what they do. During that time they deal with nothing but normal, uncomplicated pregnancy and birth. When you’re an expert in the ‘normal’ of something, you’re also very keenly aware when something is abnormal. When something is beyond the expertise of a midwife, they will refer you to someone who is an expert. In the case of having a baby at home, they come prepared with all the supplies you would find in a hospital – they have a portable version of it all. They don’t just show up with a pair of gloves to “catch a baby”. They’re professionals. So I don’t mean that there should be no use of medical equipment and supplies.

So here are some thoughts about what I do mean when I talk about natural childbirth. And do understand this explanation will not be exhaustive or necessarily well-expressed. I’m doing my best to put my thoughts into words, so bear with me.

When talking about natural childbirth, I’m talking about not intervening unnecessarily. Every woman’s body is different, every baby is different. Every birth will be different, and what woman doesn’t love a good birth story? We’re compelled not only by the wonder of new life, but I think also by the diversity of it all. Every story is different, and every story has the ability to amaze us. Given the fact that everyone is different, it would make sense that there should be room in the medical mold for my birth to look different from the next woman’s. For instance, the accepted ‘normal’ length of gestation is 40 weeks. One day over that, you’re considered overdue, and many doctors will artificially induce labour when a woman is ten days overdue – this happened twice to me. I wasn’t induced because there was any perceived risk to me or baby, it was just because I was ‘late’, and uncomfortable. Anytime you interfere with the natural process, the risk of further intervention increases. Being induced meant I was confined to the bed because of constant electronic fetal monitoring. Being unable to move and work with the process of labour, I reached a point where I felt I could no longer handle the contractions, and asked for an epidural. This meant I needed an IV. After getting the epidural, labour slowed down, resulting in the need for Syntocin to make labour speed up again. At the time I didn’t question any of it – I thought, “These people deal with birth every day, they’ll know what to do better than I will.” I didn’t take the time to prepare myself for birth and how to deal with the experience.

What I mean by natural childbirth is listening to what’s happening with your body, and responding accordingly. Yes it hurts, but this is not pain without purpose. The onset of labour tells you that something is happening. Movement helps labour progress, laying down slows it down. Anxiety and tension will serve to slow down and fight against what your body is trying to accomplish – getting that baby out! – and working with your body will bring you closer. The use of drugs will dull or eliminate the pain, but that won’t motivate your body to do what it needs to do.

I think there is a great amount of secrecy in our culture when it comes to labour and birth. That secrecy amounts to a lot of fear in women. When all we see of it is a woman on TV who goes from carefree one minute to crying out with the first contraction and doubled over in pain, rushed off to the hospital to be ‘delivered’ of her infirmity, birth becomes something we fear. It seems scary, and we hear a lot of scary stories about it. We know the pain is worth it in the end, but for goodness sakes, give me something to rid me of the pain! I’m not saying it’s wrong to use drugs, but I do believe that something is lost in the process. There is something unexplainably empowering about giving birth to a baby without the use of drugs – it’s a kind of “I am woman, hear me roar!” moment, where you feel as though nothing is impossible. I just feel like when we surrender to the widely accepted medical process, with all its possible interventions, capable women have something taken away from them. We believe a message (that I believe is not an intentional message, but a message nonetheless) that our bodies are broken and incapable and we need help to birth our babies, when in 98% of cases, little help is needed other than loving encouragement and support to do what God made us able and capable to do.

My heart in all this is to speak up about something I never heard anyone speak up about when I started having babies. Stuck in a bed with an epidural is not the only way to have a baby, nor is it the best way, in my opinion. Drugs and interventions have side-effects for you and baby. There is something else, something better. You’re not sick, your body is not broken, and you are strong. God designed your body perfectly.

One Response to “Clarity is an elusive beast.”

  1. JM Says:

    Hi Kim,

    I’m actually on the labour floor right now (just finished delivering a baby), and there’s some down time, so I thought I’d respond.

    Thanks for this post. It was a helpful summary of what you mean and don’t mean by “natural childbirth.” And I think that we are essentially in agreement: we don’t want there to be unnecessary intervention. You’re right—unfortunately modern medicine has tended to err on the side of over-investigating and over-intervening in the childbirth process. But I think there is a real shift away from that mentality in the current medical community. Again, this is a summary statement of the SOGC’s goal of labour management:

    “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.”

    We don’t want to intervene for intervention’s sake or for convenience’s sake. We only want to intervene if we believe that it will result in better outcomes.
    I guess the potential friction arises when we debate about what intervention is necessary. The term “necessary” is a bit problematic. When many people refer to a “necessary” medical intervention, they are thinking of an intervention that is essential or indispensible, without which there will certainly be an adverse outcome. For instance, if an individual has had a head injury or some overdose significantly impairing his level of consciousness so that he can’t breathe spontaneously, aggressive airway management (e.g. putting a tube down his throat and ventilating him) is necessary. Without it, there will certainly be a terrible outcome.

    However, there is another type of “necessary” intervention. In some scenarios, a patient has a particular risk factor for a negative outcome. The sheer presence of this risk factor does not mean that she will certainly have the negative outcome, but that she’s statistically more likely to have it. The intervention is used to reduce the likelihood of this negative outcome. Interventions often have risks, so it’s important to determine the risk-benefit ratio. When the potential benefits of the intervention outweigh the potential risks of the intervention (or, to put it another way, when the potential risks of the negative outcome outweigh the potential risks of the intervention), the intervention can be regarded as “necessary.” In other words, it is the standard of care, yielding the best results as born out in large-scale studies.

    For instance, in the last four to five weeks of pregnancy a woman is screened for GBS (a type of bacteria that colonizes the genitourinary tract of 10-30% of women). This bacteria often causes no trouble to the woman, but can be passed on to the newborn during a vaginal birth. 40-70% of newborns born to GBS carriers will be colonized. 1-2% of these infants will develop GBS disease (e.g. sepsis, meningitis, pneumonia). The overall incidence of GBS disease in a newborn is 1.8/1,000. The standard of care is to give IV antibiotics to a woman in active labour if she is a carrier of GBS. Giving these antibiotics has reduced the incidence of newborn GBS disease to 0.28/1,000. If the woman refuses the intervention, there is still a good chance that her baby will not have GBS disease. However, the baby is more likely to have GBS disease—the results of which can be devastating. There are some risks to giving women IV antibiotics; however, these risks are quite small when compared to the risks of GBS disease in the newborn. Therefore, the risk-benefit ratio tips in favour of giving the antibiotics. It can therefore be regarded as a “necessary” intervention. A doctor would be negligent to not suggest that a patient receive this intervention.

    A similar analogy of everyday experience is a seatbelt. Most of the time a seatbelt is not “necessary” in the absolute sense. However, if you are in the relatively rare situation of a car accident, you really want to be wearing one. The risks/inconvenience of wearing a seatbelt is minimal compared to the potential risks of being in a car accident when not wearing a seatbelt. Therefore, it is recommended that we wear seatbelts all the time.

    (Many medical risk-benefit considerations are not as cut-and-dry. I realize that.)

    You mention the scenario of being induced for being post-dates. Many natural childbirth advocates are opposed to this policy of inducing sometime between 41 and 42 weeks. You’ve probably read countless anecdotal testimonies of women who have had healthy normal babies at 42, 43, even 44 weeks. These stories are true. Just because you give birth to a baby post-term (> 42 weeks) does not mean that you will certainly have a negative outcome. However, the best available data (a meta-analysis of several trials found in the Cochrane database, which is the most robust, authoritative voice in medical literature) has shown that when compared to expectant management (i.e. just waiting until the body kicks into labour), a policy of induction at 41 weeks or more is associated with decreased perinatal death and decreased meconium aspiration syndrome. This policy does not result in increased C-section rates or vacuum or forceps deliveries. Yes, there are some risks to elective induction, but the benefits seem to outweigh the risks, which is why most physicians will recommend that if the gestation age is certain and you are post-dates, you should be induced somewhere between 41 and 42 weeks.

    You’re absolutely right: women need to be involved in the decision making process when it comes to childbirth. Women certainly want the best outcome for themselves and their babies, so they should be informed. I’m thrilled to see more and more women becoming active in this process—going to prenatal classes, asking questions of their caregivers, reading and doing research. It’s just important that the information they are getting is the most accurate information. And we have to be aware of the confirmation bias—the tendency for people to “favor information that confirms their preconceptions or hypotheses regardless of whether the information is true,” leading them to “gather evidence and recall information from memory selectively, and interpret it in a biased way.”

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