The Business of Being Born

In light of my good friend Theresa's new and quickly growing bean, we got together on Friday night to watch a documentary produced by Ricki Lake called 'The Business of Being Born'.  It had been recommended to her by another friend and I wanted to see it as well, so we gathered together in our pajamas (Theresa with saltines in hand) and settled in for an evening of baby talk.

Some of you may find my thoughts and feelings about this film and maternity health care to be somewhat controversial, and for that I apologize in advance.

In 'The Business of Being Born' Ricki Lake presents the case for midwives, and against hospital birth.  The film explores the practice of maternity care in the United States dating back to the early 1900's, and the upward trend towards hospital births.  Some interesting and surprising facts and observations were presented:

*In 1900, 95% of births in the United States took place at home.  In 1938, that number had shrunk to half.   Today, the number of home births is less than 1%

*The United States has the second highest infant mortality rate among developed countries.

*The rate of cesarean section births in the United States is 1 and 3 and quickly approaching 50%.

*'Emergency' cesarean sections peak at 4pm and 10pm, presumably because at 4pm the doctors are ready to go home for dinner, and at 10pm they are tired and not wanting to be around all night waiting for a mother to birth on her own.

All that said, I've always known that when the time came for us to have a child I would be more terrified of the hospital than of the actual birth.  The process of birthing a child is a natural human function, and in the United States we tend to view it more as a disease.

Consider this: women in labor who are left to decide the best physical positions to take will often choose to walk, rock back and forth during contractions, and squat for the actual birth.  This makes sense, as such movement helps the baby move through the pelvis, and the squatting position makes the actual birth much quicker, easier, and successful without the mother tearing or having to push too hard.    The mother is also encouraged to eat and drink for energy, as laboring women burn thousands of calories.

Alternatively, women in labor who enter the hospital are immediately strapped to a series of IV's and fetal monitors, told not to eat much if at all, and and become a study subject for nurses to rush in and check stats.  In most practices (I'm not speaking to exceptions, I realize there are some) they do not walk or move, but lay in bed and wait for the baby to fight its way out.  When this process starts to take too long (and it nearly always does), the labor is further induced with the synthetic version of a natural hormone called Oxytocin.  Oxytocin is responsible for the contractions a mother gets during labor, and it's synthetic counterpart Pitocin results in much longer and more painful contractions.

Pitocin is routinely administered in a large and disturbing percentage of hospital births (just watch 'A Baby Story' or 'Birth Day'); studies just coming out are showing that the use of Pitocin to augment or induce labor may be related to the increased number of children in the United States suffering with learning disabilities and ADD/ADHD disorders.

As a result of the increased pain, the mother often requests an epidural (administered through a catheter directly into the spine).  This process in and of itself is simply terrifying to me: however some women swear that receiving an epidural is the only way to give birth.  Once an epidural is given, women are often given a bladder catheter as well because they cannot walk.  A side effect of the epidural, however, is that labor almost always slows down or comes to a complete stop.

The solution?  More pitocin, which, because of the longer, harder, false contractions it creates it often leads to fetal distress; the babies heart rate will drop and fluctuate, sending an alarm to the nurse staff.  It is a tragic series of interventions where one leads to another, and a baby in distress is never a good thing.   So, the doctors and nurses rush in to 'save the baby' and the mother starts pushing (on her back, of course, fighting gravity and her numbed pelvis).  Just as the head is crowning the doctor will often perform an episiotomy, presumably to keep the mother from tearing which is a real possibility considering both her induced disability and position.  Vacuums and forceps may also be applied, tools that improperly used in the 1970's caused an increase in the number of children born with cerebral palsy.

Once the baby is out, mom is sewn back up (episiotomies often lead to infections, or worse, incontinence but are considered 'necessary'  and routine by some medical professionals) and the baby is quickly rushed away for evaluation, getting not so much as a quick glance from the drugged and relieved mother.

The doctor is credited for 'saving' the distressed baby.

In the 1 in 3 scenario, the cocktail of pitocin and epidurals results in a cesarean section; invasive abdominal surgery that probably could have been avoided.  Here is an interesting article on the connection between labor induction and intervention to the high rate of cesarean sections in the United States.  http://www.childbirthconnection.org/article.asp?ck=10456

In the film, one of the worlds most famous midwives, Ina May Gaskin stated that it was not until home birth #187 that she needed to transfer a woman in her care for a cesarean section due to complications.

The primary argument against midwife attended births at home or in birthing centers is the risk of complications.  Many people question the safety of giving birth without a doctor and all of the modern technology offered in the hospital.  Personally, I question the defensive medicine practiced by doctors at healthy births where no complications are likely to arise.  Complications are created by women forced to birth on the back, by women who are infused with synthetic hormones, and for women who are considered 'in distress' when their natural labor is taking more time than the 8-10 hour shift the doctor is working.

I believe in the miracle of modern medicine for births where natural complications arise: in the film the producer went into labor several weeks early with a breech baby, and a cesarean section saved his life.  But when the time comes for Dave and I to have a child, I'm looking forward to the birth experience: I am not afraid of it.  What scares me is enduring the standard experience women have at hospital births in shows such as 'A Baby Story' and 'Birth Day'.  I want to be alert, in control, and have that baby in my arms when it comes out (not on an examination table).  A common trait of women successful in natural birth is that they accept the pain instead of trying to fight it, and all women who experience it say they would do it again in a heartbeat.

I'm the least feminist and one of the most conservative people in my age group, but when it comes to natural, 'granola' birth well, I'm all for it.