May 4, 2009

Birthing is Business?

Last week, I picked up "The Business of Being Born" from the library. It's a documentary made by Ricki Lake and Abby Epstein about birth in the United States. I'm very interested in the topic, and lately have been reading and looking on the internet. No, I'm not pregnant, and it's actually possible that I won't be pregnant again. But I feel that after my own birth experience, I became even more interested in other women's experiences and what birth can be.

This was a very informative movie. Yes, it is one sided. But I think that a lot of valuable information is included about how we see birth in the United States.

I thought about having a midwife for my son, but never did anything about it. I liked my OB, in hindsight he wasn't the best before conception and should have referred us to a fertility specialist sooner, but as far as the pregnancy and birth went, he was great. Midwives attend over 70% of births in Europe & Japan. In the United States, it's less than 8%. In the movie, they point out that very few doctors have ever observed a normal, natural birth in med school or at the hospital. Obstetricians are trained surgeons. That's what they are trained to do. Midwives are trained to help women give birth, and to help their bodies do what they are supposed to do. Dr. Jacques Moritz, one of the doctors featured in the film, goes as far as to say "For a normal, low risk woman, it's overkill going to a doctor. It's just too much, the doctor's not really excited about things when they're normal." Dr. Jacques Moritz St. Luke's Roosevelt Hospital

The bottom line is that the average labor is 12 hours, a c-section takes 20 minutes. Peak times for c-sections taking place are 4 pm and 10 pm. Once you're in a hospital setting, it's almost certain that you will be in one of two situations. Either your labor will progress so fast that drugs are not an option, or you'll be given pitocin to augment and speed along your labor. Once that pitocin drip starts, you're on a slippery slope into a situation that starts to snowball. I experienced it during my labor - I new when they gave me pitocin that I wanted the epidural first. Pitocin pushes you into hard labor fast. Without drugs, it can get really painful really fast without working up to it. 90% of patients at some hospitals are put on pitocin. The pitocin leads to an epidural, which can lead to slowed labor, more pitocin and contractions that are so long and hard they send the baby into distress, leading to a c-section. If pitocin hadn't been given in the first place, a lot of mothers might be experiencing a more normal and natural labor instead of major surgery. Speaking of which, it seems like people forget that a c-section is a major surgery. The more you have, the higher the risk, and sometimes it can lead to antibiotic resistant infections. Yet, in subsequent pregnancies, many doctors will not recommend a vbac (vaginal birth after cesearian). Maybe they're afraid of getting sued, maybe they want to take the route that's easier on the schedule and just get that c-section fit in to a day at work. Whatever the reason, many women who could easily and safely experience natural childbirth after a c-section are not really given the opportunity. I think that a lot of women don't know, or it doesn't occur to them, that they can choose to switch doctors or fight harder if it's something they really want. We tend to blindly trust in medical professionals even when we might have a few doubts.

I knew before I went into labor that I wanted to try something different. I knew that birthing laying down on your back is not ideal, and I wanted to try squatting with a birthing bar, but the epidural made that impossible. One of the doctors in the film pointed out that the vertical birth (squatting or sitting up) is on the mother's time and will happen more smoothly on it's own.
There was one video of a woman giving birth at a birthing center. She was in the position that felt comfortable for her, leaning against a bed with her knees slightly bent. The midwives/support people were all squatting around her, on the floor, accomodating HER. It immediately came to my mind that this is the way birth SHOULD be.

I totally agree with the point they make in the movie that women in America don't have a normal picture of birth - TV shows screaming women and chaos, and women become afraid of the experience of giving birth. now, I think a certain amount of fear or reverence is healthy, but I definitely think I was more afraid than I needed to be about giving birth and the labor process. I was provided with plenty of images of hard births, of sweating and screaming. I was not provided with any images like some of the ones in the video, women birthing quietly, peacefully, on their own terms. There were a couple of videos of home births with midwives in the movie. One in particular was amazing, an African-American woman giving birth in a birthing pool. She moans during labor, but the delivery is serene and peaceful and almost spiritual. Ricki Lake had her 2nd birth at home and had her baby in the bathtub. Not as quiet, but also obviously a transcendant moment.

I think we should be asking ourselves why the US has the second worst newborn death rate in the developed world. We also have one of the highest maternal mortality rates in all industrialized countries. Dr. Michael Odent, one of the doctors featured in the film says "The fact that midwives have disappeared is a symptom of the fact taht we no longer remember what women in labor NEED [basic needs]. Today what we need to discover is how easy birth can be."

Why is home birth 'abnormal'? In 1900, 95% of births took place at home. In 1938 it was down to half, and today less than 1% of births take place at home. It's really interesting to me, because just like the doctor who said that a doctor may be overkill for a regular birth, perhaps it's true that a hospital may be overkill for a normal, uncomplicated birth. Women had their babies at home for hundreds and hundreds of years, and in many parts of the world, that's still the norm. But because of the way that birthing is portrayed in our society, I don't think that most women even consider home birth an option. Going to the hopsital is just what we do. But, guess what? Midwife/home birth can run $4000 while a normal hospital birth can run $13,000. We spend twice as much in the US per birth than any other country in the world. Why?

In the 1970s, fetal monitoring started to become the norm during labor. The c-section rate went from 5% to 25%. By 2005, it was up to 33%. Sometimes, having too much information might not be a good thing. Fetal monitoring allows the doctors to see every tiny thing. In some cases, it probably does save mothers lives and babies lives. But it's also worth thinking about what is being 'too careful' and leading to unnecessary interventions for mothers and their babies.

At some point during the movie, someone wonders if there could be a link between ADD, Austism etc. and birth interventions. Now, I freely admit that I don't know any facts about this, but it's an interesting idea. We could discover later that certain things being done now are having effects we don't know about (like thalidimyde). It's always a possibility.

Oxytocin, the natural chemical released during labor, birth and breastfeeding, promotes maternal agression. They are a love hormone, create a state of dependancy, addiction, attachment and maternal protection of the baby. Pitocin doesn't affect the brain the same way. could this be having an effect on the way we bond with our babies? In my mind, undoubtedly it causes changes. I'm not saying that it's the same for all women, but I wonder how many of the women who are not able to bond with their child right away might have been able to if they'd had a more natural labor? It's incredibly sad to me. It makes me wonder what I would have felt during birth if I'd held out and not augmented so soon, how much different would my experience have been? What would I have felt?

The filmmakers still believe that there are many options for every woman. Abby Epstein, the director, is pregnant and before the movie is over she goes into labor early and ends up having a c-section because her baby is breech and can't be turned. And it's okay, because that's what is best for that baby and that mother in that particular situation. Despite the fact that the film is providing information that is obviously skewed in one direction, I didn't feel like it was condemning any women for their choices. It's facts, it's information, it's another side to the story.

I don't know if I'll ever have another baby. Right now we're on the fence, and we're just not sure if another child is in the cards for us. If I have another one, I'll do things differently. I will check out the birth center here in Bellingham, and I will probably try hypnobirthing, and maybe water birth. I will try going much further into labor before asking for drugs. I wasn't at my breaking point last time, I only got the epidural at that point because I knew the pitocin would throw me into hard labor. If I knew then what I know now, I would have waited longer before getting the pitocin, if I got it at all. I'm sharing this stuff because I think it's important, I think that women need both sides of the story before they make their decisions, and a lot of the time they're not getting that.

How was your birth experience? Would you have done anything different? Did you do things differently with your first, second, third?


The Blonde Duck said...

Interesting post! Popped in to say hi from SITS!

Mimi said...

I would have loved to try all of the home birth but couldn't the first time because of my placenta was blocking the way & the second time had to have a repeat c-section after my uterus began to actually tear.

I do agree that having a birthing midwife or doula is the way for any woman to go.

Keeper of the Skies Wife said...

I wanted to have a midwife but my husband was so against it. My daughters have said they will take that route when they become pregnant.

Dumblond said...

When I was pregnant with my son, I had not heard of home births, birthing centers, doulas or midwives. I went to an OB, went to a hospital...and ended up having a c-section. I was a few days over due, I had very high blood pressure so they induced me. After 12 hours, my progress stalled and even went backwards. The doctor was afraid of infection so I went to the OR.
When I got pregnant with my daughter, I briefly entertained the idea of a VBAC but the idea totally horrified my husband so it was a scheduled c-section.
If I knew then (way back in my first pregnancy) what I know now, I might have done more research...checked my options. I don't know if the outcome would have been any different...
But when my children are grown and starting families of their own, I will definitely make sure they have more info than I did.

Anonymous said...

Very interesting and thoughtful post. Thanks!

adriel said...

Hi Racheal! I'm finally visiting from 31DBB... Feeling mildly (ok, totally) swamped with all that I want to do blog-wise these days. But part of the reason I wanted to do this was to connect with others... so here I am finally! I was able to watch this DVD when I was pregnant with my son. At the time I had already been accepted into the local birthing center and wa working with a midwife. I wanted to have a water birth, no interventions, but ended up with a c-section for my little breech monkey! I was pretty disappointed that I hadn't had an ultrasound to pick it up earlier so that we could have tried turning him, but we didn't discover this until I was already 12 hours into labor (mostly early labor). At the birthing center they are not allowed to deliver breech babies, so after 9 months I was automatically disqualified. It was pretty heart-breaking... and yet it was also a really beautiful birth still. (My emotions about all of it didn't really hit until a couple months later when I found out that the c-section disqualified me from future births at our birthing center - that was even harder than the c-section itself because while having it I had thought "there's always next time".) But I whole-heartedly agree that most women aren't educated enough about birth going into it. For me, that was the key to being confident (and not terrified). My midwife was amazing in that way - she really empowered me as she taught me. I thought this was a great film too - though obviously very one-sided (and I thought even unfair at times). Though I am a natural birth advocate for whenever it's possible, I also know that you just never know. I'm glad this film is out there and I hope it keeps getting circulated. More women need to understand that we have options!

Rachael1013 said...

@Adriel - Yes! I think that my main problem is that women are so rarely
presented with all the options available to them. I'm sorry that your birth
center doesn't do VBACs, that is a huge issue in this country. Even though
a really high percentage of women who've had c-sections would be perfectly
fine delivering vaginally after a c-section so many doctors do not even
allow them to try. It's really a bummer. Especially in cases like yours
where the c-section was for a breech baby and not a medical issue.