As seen in issue 56 of Closer Magazine, published on 2009-03-27 in the "Featured" section.
childbirth becomes increasingly medicalized, more women seek alternatives
By: Tuesday Gilliam
"Our medical system has convinced women that they don’t know how to give birth, that without modern pharmaceuticals and technology they—and their babies—would be lost"
This is what you hear from most women in the U.S. when they talk about their experience giving birth:
“My doctor said because of [any of a number of reasons: big baby, past due date, risk to baby, labor not progressing, low amniotic fluid, small pelvis] I would need to be induced. First they gave me Cervidil to soften my cervix. Then they gave me Pitocin to start the labor. When the contractions grew strong they gave me an anesthetic to ease the pain. That left me numb below the waist which slowed down the labor so they gave me more Pitocin, which made the contractions more intense again so I was given more anesthetic, which slowed the labor down again so I was given even more Pitocin.”
“Although I was not feeling anything my baby must have been feeling something because her heartbeat kept slowing down, according to the machine strapped to my waist. Then the doctor came in and said we were not progressing at the rate she would like and that the baby was in distress. We all agreed that an emergency C-section would be necessary. Thank god we were in the hospital.”
Most women have faith in their doctors and don’t argue with the interventions offered in a hospital birth. As a result, one in three births in the U.S. now occur via Caesarean (C-section). Eighty-one percent of women in U.S. hospitals receive Pitocin either to induce or augment their labors, according to a survey by Robbie Davis-Floyd, a medical anthropologist and senior research fellow at the University of Texas.
Skeptics—Davis-Floyd prominent among them--say our medical system has convinced women that they don’t know how to give birth, that without modern pharmaceuticals and technology they—and their babies—would be lost. Outside this system, to avoid medical intervention, a small but growing number of women are practicing childbirth at home—with the care of a midwife--or at birth centers. They aim to take childbirth back from the medical establishment and return it to the hands of the childbearers.
The Love Hormone
Because the fetus has such a large head and upper body structure in relation to the size of the mother’s pelvis, a complex series of actions is required to emerge from the mother. Critical to this is dilation, the widening of the cervix, the narrow portion of the womb where it joins the birth canal. Usually, dilation and labor begin once the fetus is fully developed, after about 40 weeks of pregnancy, when the lungs are fully developed and ready to breathe air.
Oxytocin, a/k/a “the love hormone,” plays a central role in dilation, as well as in the uterine contractions that propel the fetus down and out of the body. This complicated combination of amino acids is manufactured in a variety of places in the bodies of both men and women—chiefly in the pituitary gland—and is released during sex and after orgasm, and when breastfeeding. It appears to play a role in emotional bonding and other social behavior in mammals.
Almost ten years ago, researchers at the University of California, San Francisco, found that oxytocin was associated with the ability to maintain healthy interpersonal relationships. Rebecca Turner, Ph.D, adjunct assistant professor of psychiatry and lead author of the study, went on to state that "Evolutionarily speaking, it makes sense that during pregnancy and the postpartum, both a woman's body and her mind would be stimulated to nurture her child.”
Advocates of natural childbirth conclude that the heightened amount of oxytocin in the mother at delivery, shared with the fetus, suffuses the two in a chemical cocktail that forges love and a protective instinct. This is the post-natal climax, the high women talk about--an inimitable feeling that is widely reported.
“The world came back in Technicolor and surround sound.” says Roseanne Catalano, a Sarasota mother of two. “Kind of like the Wizard of Oz when it changes to color! My focus had turned so completely inward during the birth that everything else had faded away. It was like my self had gone inside my body and left my senses behind on the outside.”
The advocates point to studies that indicate that medical intervention during labor and/or after birth interferes with this bonding.
According to a study led by Yale Child Study Center Assistant Professor James Swain, M.D., a stronger bond is created during natural childbirth than a C-section.
“The team found that compared to mothers who delivered by cesarean section, those who delivered vaginally had greater activity in certain brain regions in response to their own baby's cry,” the study found. “These brain areas included regions that regulate emotions and empathy, as well as deeper brain structures that contribute to motivation, and habitual thoughts and behaviors.”
“These results provoke many questions and may help expectant mothers as they consider their options carefully,” says Swain. "I suspect that the parental brain is 'primed' by vaginal delivery and affected by neurohormonal factors such as oxytocin. C-sections may alter these neurohormonal factors and increase the risk of problematic bonding and postpartum depression."
The Doctor Will C You Now
C-sections and other medical interventions such are a great way to monitor, schedule and plan what has traditionally been a spontaneous occurrence. And in our hurried, regimented society, scheduling seems to take precedence.
The World Health Organization recommends that the rate of Caesarean sections should not exceed 15%. Yet in 2006, the rate of births by C-section in the U.S. was 31.1% and rising. In South Florida, the C-section rate is 36% of all births. In Miami-Dade County, in 2006, the rate was 44.8 percent. In Palm Beach County, the rate has doubled in the past ten years, and is now over 40%.
Money—both medical malpractice awards and medical malpractice insurance--is one factor in the rise of C-sections. In the Palm Beach Post last August, medical reporter Phil Galewitz wrote:
Most obstetricians in Palm Beach County have dropped liability coverage because of the high cost, and some believe doctors are less likely to be sued if they perform a C-section.
"Every doctor knows you can't get sued for doing a C-section, but you can get sued for not doing one," said Dr. Allan Dinnerstein, an obstetrician at Bethesda Memorial Hospital in Boynton Beach.
Dr. Peter Dayton, a Stuart obstetrician, said flatly: "C-sections are only related to one factor: malpractice risk."
Then there is the raw bottom line: C-sections pay more per birth. An emergency C-section costs anywhere from $13,000-18,000. OB/GYN’s get pretty much the same amount no matter how the baby comes, averaging $2,000, but hospitals benefit greatly. C-sections, for a hospital, average about $16,020 vs. $8,500 for a regular hospital birth.
This is one of the instances in the healthcare system where cheaper is actually better. The outcome for mother and child is incomparable in a natural birth. A midwife assisted homebirth or in a birth center on average is about $1,200-4,000, and the majority of that money is spent on the time the staff endures. This amount includes everything from pre-natal visits, tests, the birth, and some after-care. Sure there are supplies needed, but for the most part the woman’s body does all of the work, there are no interventions on the bill of a fully natural birth.
Midwives, doulas, and birthing centers are privy to the needs of the mother and newborn. These women understand the need for an alternative for those who see birth as a natural process and not a medical illness.
A doula (the word comes from the ancient Greek term for a female servant) is a support person who stays with the mother throughout labor and birth and post-partum. Although most doulas are trained and certified, a doula does nothing medical, and is there solely to offer emotional and physical support.
Midwives, on the other hand, are highly skilled and trained at what they do, and are of two types. Licensed or Certified Professional Midwives follow the European Guidelines of Midwifery and get their degree from a midwifery school; Certified Nurse Midwives have a nursing degree.
Florida, luckily, is a midwife-friendly state—one of eleven that recognize Licensed Midwifery, allowing them to work in homes or birthing centers. In Georgia, for example, it is illegal for midwives to attend home births, though parents will not be prosecuted for the practice.
According to the latest Florida Medical Quality Assurance annual report, there are 115 active licensed midwives practicing in the state, with about 11 percent of births attended by midwives. The Florida Council of Licensed Midwives reported that births attended by Licensed Midwives in the state grew by 5.5% from 2005 to 2006.
Even here, however, training for midwives struggles to survive. Miami Dades College’s Midwifery Program was shut down last August—over the strenuous objections of many--due to “low enrollment.” This program had trained 80 Licensed Midwives since 1995.
In contrast to the mechanized, automated methods of interventions in the modern maternity ward, midwives do not use IV’s or continuous monitoring devices strapped to the belly. There are no catheters, wires or tubes coming out of the babies head or woman’s body. There are no vacuum pumps to pull the baby out and no stirrups to hold a woman’s legs.
What happens instead is that women are encouraged to move around and eat and drink when in labor. Candles are lit and soft music plays. Previous children may visit. Meanwhile, the midwives wait patiently nearby until transition begins. Then they join the mother in whatever position she chooses in which to bring the baby in the world. An increasingly popular option is water birth, in which mother and father together have the baby delivered in the warm, moist environment of a large tub of water.
South Florida has several birthing centers--designed for a home-away-from home birth. Fully equipped with apartment suites, huge bathtubs, and plenty of space for the whole family, and for a laboring mother to move around, birthing centers offer everything a hospital does except the drugs.
None of this is to say that natural childbirth is free of pain. There's a reason it's called “labor.” But according to Anita Phelps, a West Palm Beach mother who has had two home births, “It’s not the kind of pain that you think. It is euphoric. One moment it is really intense and in between contractions it is the most sensual, heightened experience. It feels so good and you just know your body is getting ready for the next contraction, and with every rush you keep saying to yourself, 'Each one brings me closer to my baby.'”