Free Birth
Should you climb this mountain alone?
At the risk of sounding paternalistic
As a physician (OB/GYN) I do not believe that any woman should be without professional support at the time of birth. Whether a Midwife or Physician you need a safety net. You need someone to Birth Assist.
At the risk of sounding paternalistic I decided to pen this blog. Hopefully after reading this you will not look at me as a money hungry, self absorbed, OB/GYN but someone who sees the need for everyone excelling in what they are trained to do.
For those who are not familiar the concept of “free birth” or “unassisted birth” is that a mom will deliver her child without the help of a Birth Assistant . My concept of a birth assistant is anyone (Midwife or Physician) that has been trained to assist in the birth of a child. I coin this thought of birth assistant because I believe that too many times patients do not educate themselves enough to actually take charge of the birth of their child and count on me as a OB/GYN to deliver their child.
Partnership in birth
is the key to placing patients in a healthy relationship with their birth assistant
The extreme of this birthing experience is the idea that a patient can spend 7 - 8 months reading text books, blogs, or looking at videos and become proficient enough to become their own safety net during a problematic birthing experience. Now I am quite aware that themajority of births are normal, natural experiences. Yet for the paucity of births that need a birth assistant I believe that a new mom does herself a disservice to not avail herself of this expertise.
Now I believe that the reason that patients turn to free birth is because of a traumatic experience under the hands of a medical professional not listening to the desires of the patient. Janet Fraser who coined “birth rape” is a prime example. Read: http://ecochildsplay.com/2009/05/... You hear in Janet’s experience a patient who felt helpless in a situation where her birthing freedom was taken away. I will not second guess the management of the Midwife but it is obvious that Janet’s experience was one that scarred her for life.
Medical education in OB/GYN focuses solely around the concept of preparing for disasters. This is why the majority of Dulas, Midwives, and birth activist look at OB/GYNs as a hurdle to having a natural birthing experience. In practice I see that the majority of patients only want to have a healthy baby and do not spend much time thinking about how their baby will be born. They count on me to deliver their baby rather than assist in the birth. From my prospective I am prepared to do both. Whether the patient will accept the responsibility to educate themselves on the experience and take control of their birth is something that I await. My job is to educate patients, prepare for the problems, but ultimately sit back and watch the glory that God intended to happen at the birth of a child.
My hope is that less and less patients will be put in the place where they feel that they are better off without the support of a birth assistant when their child is born.
A. Harris Sr., MD
Dayton, OH
Let me begin by saying I do not think you are money-hungry or self-absorbed. I think you care about birthing women and I'm guessing you follow more of the midwifery model of care, or you would LIKE to, than the medically managed obstetric one.
ReplyDeleteTo suggest that all/most women who UC prepare by reading a few books/watching a few videos over 7-8 months tho, seems to be a little bit under researched. Where did you get that info? Laura Shandley has a LOT of interesting information about unassisted birthing on her website: http://www.unassistedchildbirth.com/uc/truth.html (I'm not tech-savy enough to make that work as a link, sorry)
Some women turn to UC because of traumatic birth experiences @ the hands of either an ob/fam dr/or midwife, but there are many others who just do it because it is what they WANT to do and they trust their bodies to complete the act of conception/pregnancy/childbirth without the need for an attendant to tell them what to do or watch over them "just in case". I don't think it is "wrong" or "unwise" but it is the woman's choice how to have her baby. True that there COULD be a devastating complication, but most complications have warning time and a mother usually knows and can seek assistance if necessary. Plus even WITH a complication just having an OB or midwife in attendance doesn't guarantee a healthy mother/baby. Babies die. Mothers die. It happens. It isn't always someone's "fault". As a mother and a birth professional I would also say that the reason I feel that most OB's are a hurdle to a natural birth experience is not their education. The disaster preparedness training may precipitate some of the actions, but my experience has been that it is the bedside manner and the OB's treatment of the mother, his telling her she WILL do as she is told, she WILL submit to continuous EFM, she WILL push flat on her back the way she is told, and only WHEN she is told she may, she WILL have an IV, after all, it is hospital policy, she will NOT have access to food/drink, she WILL probably have an episotomy and the cord WILL be cut immediately, and so on and so forth. It is that paternalistic mentality that makes him a hindrance to natural birth. I am thankful that not all OB's are like that. Still no matter, the woman should be able to choose without condemnation who, if anyone will atend her birth, and where it will occur. Fun topic!!
I took the time to read Laura Shanley's blog... very interesting. I'll submit the following comments
ReplyDelete1) Laura is a unique woman in that she has delivered and will always deliver her own children. Yet I see her as the exception rather than the rule.
2) The idea that a mother just instinctively knows that there is a problem with her baby at the time of delivery and also knows exactly what to do at that time is something that I can not say that I truly except.
3) If patient's educate themselves I believe that it puts them in the place where they can take control of their birth.
As concerning UC I still stand by the statement that the patient is reading blogs, web pages, books to get their information. The part of the equation that is missing is the mentoring and years of experinece that Birth assistants get in their prospective areas of training. Nothing can substitute for experience and until the patient has delivered several of her own children she can not have that experience. I believe that it is a mistake to throw away the years of medical education as well as the balance of understanding that mom's can labor and deliver normally. I am personally on the quest to find the balance. Yet I must have a motivated patient otherwise I go back to delivering their child rather than particpating in their birthing experience. HarrisMD
Thank you for visiting my blog. I actually have much more information on my web site and in my book, Unassisted Childbirth. It's hard to sum up my philosophy of birth in one comment but I can briefly share some thoughts with you.
ReplyDeleteI don't believe I have any special abilities. Throughout history women have successfully given birth unassisted. And while most people believe that death in childbirth was routine prior to the advent of the modern day hospital, a thorough study of history shows this was not the case. Judith Goldsmith writes in her book Childbirth Wisdom from the World's Oldest Societies that in healthy tribal cultures, death or complications in childbirth were rare. When mothers or babies did die it was almost always a result of poverty (lack of food, clean water and adequate housing) and/or unsafe tribal practices. Physician Michel Odent agrees. In his new book The Functions of the Orgasms (which is actually about birth) he states that childbirth has been culturally controlled for thousands of years. We cannot get a good picture of what true unassisted childbirth looks like by studying birth in third world countries because not only are these women starving to death, they're also subjected to numerous unsafe tribal practices such as taking the baby away from the mother after birth (sometimes for several days). Fear of colostrum is almost universal and so babies are often either not nursed at all in the hours or days after birth or they're given bread and whale blubber which their digestive systems cannot handle. Often dung is rubbed into the umbilical cord which leads to infection, and women and babies are forced to sit in front of hot fires for days. These are only some of the unsafe tribal practices that make birth dangerous. The countries with the highest maternal mortality rates are also the countries with the highest rates of female genital mutilation.
In other words, there are reasons WHY women and babies in tribal cultures (both now and in the past) sometimes die in childbirth and it isn't because birth is inherently dangerous. What kind of sense would it make that the very act that insures the continuation of the race would be fraught with peril? It makes much more sense to me that birth has been designed beautifully by the larger consciousness, but certain conditions are needed in order for it to unfold safely. Women need to be well-fed and treated kindly, and they need to trust their bodies so that they don't trigger the fight/flight response which shuts down labor. And so this is the other factor I focus on - helping women rid themselves of fear so they don't produce stress hormones which literally shut down labor.
The third factor that makes birth dangerous is unnecessary medical intervention. Women who give birth in hospitals are subjected to all sorts of unsafe practices. Each stage of labor is managed and controlled. And if a woman doesn't give birth quickly enough, she is given pitocin to speed things along. The pitocin makes the contractions more painful so often she "needs" an epidural which slows labor down. One intervention leads to another and finally a c-section is "required." Maternal and infant mortality rates have gone up in American hospitals in the last few years, not in spite of medical intervention but because of it. According to a story on my local news, every 15 to 20 minutes a baby is stillborn in an American hospital. This is double what it was 10 years ago. I believe most of this is due to induction of labor, c-sections and other interventions.
I don't question your devotion to mothers and babies. Doctors are often blamed when something goes wrong (hence the desire to manage and control birth) and many times it is not their fault. Sometimes babies die and nothing can stop it. And yes, I give doctors credit for sometimes saving lives. But the interventions routinely performed on mothers and babies today are not based on true science, and in most cases they are not safe or needed. I have never commented on a doctor's blog as I find that most M.D.'s are not willing to even entertain the possibility that I might have something valid to say. But you seem more open-minded than most, so I hope you are the exception. :)
The Gift of Fear was given to me by the Kettering Police Department at the completion of their RAD class. (www.rad-systems.com) It is a #1 bestseller written by Gavin DeBecker, who was a 3X presidential advisor. The most important factor in protecting yourself from harm is trusting your intuition. Granted, this book is about protecting yourself from harm from violence, but it makes an important point that can and should be carried over to other aspects of living, including your medical care. He says, "React to the signals your intuition gives you, if and when they occur. Trust that what causes you alarm probably should, because when it comes to danger, intuition is always right in at least 2 important ways: 1. It is always in response to something, and 2. It always has your best interests at heart." The point I am making here is that the woman has all of the information about her body/her birth and her intuition will guide her. She is designed to function this way. Birth is designed to happen all by itself even if there is nobody else to assist. As long as the woman is not filled with fear, is healthy and well-nourished, and follows the cues of her body, she can accomplish the feat without assistance. Pregnancy/birth is not a medical condition which requires treatment, it is a physiological response to a miraculous event: the joining of the sperm & egg to create a new and unique individual person. It is not a cancerous growth that needs to be extricated by a surgeon. That said, there are sometimes (very rarely...no more than 10-15% of the time according to the WHO) when complications occur which do necessitate intervention. I believe that a woman in tuned to her body and her baby, will almost always recognize a need for help and seek it. You certainly need medical training and experience to perform a cesarean, but it is completely unnesessary to have the same to birth a baby naturally.
ReplyDeleteAnother aspect to consider when it comes to maternity care, is that of the provider/client relationship. Dr. Harris, you call your clients "patients" which suggests you are/should be in authority over them. In fact, they are consumers. They are paying you for your experience/education and should seek you to provide experience, information, and recommendations based on that. However, the decisions as to what treatments/if any, should remain with the consumer. She is the one who will live with the choices that are made.
I do agree that many, maybe even most women, want the provider to take control and make the decisions for them. That is what leaves you vulnerable to lawsuits, I think. They want YOU to be the one responsible, when they should be taking the responsibility for the choices that are made.
I applaud your quest to serve your clientelle wisely and well.
Blessings!
Denise
You stated "According to my local news, every 15 to 20 minutes a baby is stillborn in an American hospital...I believe this is due to induction of labor, c-cestions, and other interventions." Please before making such a blanket statement provide more evidence and statistics. You fail to mention that our society is also moving towards women giving birth at a more advanced maternal age which brings along more complications to pregnancies. Fertility assistance will not even accept egg donors over ages 30-32 due to the mutations that can occur. Your statement is an unfounded reasoning as to what is causing the increase in stillbirths and needs further documentation of possible causes such as genetic mutuations, congenital conditions, birth defects, etc. You seem to be skewing the statistics to benefit your argument.
ReplyDeleteI have had 4 pregnancies, with the last being a set of twins. 2 of the 4 pregnancies were high risk with preterm labor. But even my other pregnancies brought complications. My first child had the cord around his neck several times and thankfully the staff was there to stop me from pushing and causing strangulation.
There are pros and cons for each side. But as the mother of a SIDS death,in the event of a death, questioning one's self is a extremely difficult and painstaking event to put yourself through. This is completely my opinion but as someone who has suffered the fate of a death of a child I MUST add this argument. If complications were to arise, having the medically trained staff there to intervene and assist is a much better option then to spend the rest of your life wondering what could have been.
Julia, first, I'd like to say how sorry I am that you have lost a baby to SIDS. There is nothing worse than losing a child. It completely changes who you are and how you view your world. I lost a baby too. He was a fullterm stillbirth. I went to the hospital for testing prior to his birth, and was sent home with satisfactory test results, despite the fact that I did not feel right about going home, and I knew that something was still not right. However, in light of the tests, I was not given any other options but to leave. My baby was dead within a few hours. Having medically trained personel present does not necessarily provide you with a better or different outcome. My very dear friend lost a baby @ birth due to hospital/physician error. Because of that, she chose to have her next 7 babies @ home, 6 of whom where unassisted, the last one they chose a midwife because she was getting older and her husband was uncomfortable being alone. It doesn't matter where you are, or who is with you or not with you, you will question yourself if your child dies. Nobody is perfect or infallable, physicians included. We can each only do the best we can with the information we have at the time.
ReplyDeleteHere is a link to the milbank report, which is posted on ChildbirthConnection.org and you can download it free of charge. On pg 35 it talks all about the cascade of interventions and the issues they cause in labor/birth.
http://www.childbirthconnection.org/article.asp?ck=10575 I think that these problems are some of what Laura is referring to as far as problems with interventions. http://fresnofamily.com/pgbirth/stillbirth.htm
That is a link to one of many studies that say that cesarean section increases your risk of stillbirth in a successive pregnancy.
Another thing you mentioned is that one of your baby's cord was wrapped around his neck, which posed the potential for strangulation. That is actually a very rare occurance to have the cord wrapped so tightly it causes that problem. Perhaps Dr. Harris could comment on this, but having the cord wrapped around the neck/body is a very common normal occurance that need not be an issue at all. It can occur in as many as 25%+ births. http://www.fitpregnancy.com/yourpregnancy/labor_delivery/when-childbirth-gets-scary-40725442.html
Oh and btw...my stillbirth was unexpained and I had had 2 previous c-section births.
I still stand by my opinion that each mother has instincts to guide her through her births and if she will listen to them, she will know if she needs more assistance or no assistance at all. Dr. Sarah J. Buckley has a lot of info on her website about these issues as well.
Many Blessings!