I’ve been doing a lot of reflecting lately on stimulating change in the birth world. I’m extremely involved in the birth community, and actively promote the creation of a more gentle and informed birth culture.
With induction rates of up to 25% and cesarean rates of up to 35% here in British Columbia, it is clear that our interventions in birth are much too high.
In addition to inducing 1 in 4 women, 25 to 50% of first time moms have their births “augmented” due to what’s described as abnormal progression. This is a huge number! I couldn’t agree more with Henci Goer when she says “If progress is abnormal in that many women, then something is wrong with the definition of normal.”
Why are we so quick to intervene? High intervention rates don’t mean better birth outcomes.
Interventions like induction and augmentation increase a mother’s risk of cesarean. And government authorities agree that it is in everyone’s best interests to lower the cesarean rate. According to Optimal Birth BC, “cesarean birth is associated with higher rates of maternal and newborn morbidity and death compared to vaginal birth, and uses considerable health care resources.”
The BC Women’s Hospital & Health Center, a Vancouver hospital that births most of BC’s babies at the rate of about 1 per hour, knows our cesarean rate is too high. In 2008, it started the Power to Push Campaign “in response to the increasing trend towards cesarean birth in BC”, stating that “research has shown that cesarean birth can expose women and their babies to health risks they do not face with normal vaginal birth.”
The importance of improving birth outcomes is gaining widespread attention. In fact, the popular Maclean’s magazine recently wrote an article on the ten common medical interventions to avoid in order to improve birth outcomes.
So if the research supports lower intervention rates, and health centers develop entire campaigns to advertise their mission to increase vaginal births, why are intervention rates still so high?
Not only does the research show that increased interventions do not improve birth outcomes, it also is clear that high intervention rates can lead to psychological birth trauma, leaving new mothers with deep wounds to heal.
So how do we really create a positive change trending towards normal, healthy birth with good outcomes for mother and baby? And by good outcome, I mean more than the traditional medical view of a live mother and a healthy baby. The psychological impact of birth experience is also extremely important.
I believe it will take a three-sided approach:
- Campaigning the hospitals and health authorities to make policy and education changes that promote normal birth
- Getting men involved in advocating for mom’s rights to decline medical intervention
- Calling out to women to “take back their birth”
1. Campaigning Hospitals and Health Authorities
Thank you to the hospital campaigns and health departments that recognize our vaginal birth rates need to be increased. But as a doula here in Vancouver who has attended many hospital births, I am going to just say it: what’s happening in our hospitals has a long way to go at this point. A recent Canadian study was done to assess the attitudes of our obstetricians towards normal birth. Interestingly, in spite of consistent research that supports normal birth, our newest generations of OBs seems to be more comfortable with technological birth and the use of interventions, finding that:
“In general younger obstetricians were more supportive of the role of birth technology in normal birth, including routine epidural analgesia, and they were less appreciative of the role of women in their own birth. They saw cesarean section as a solution to many perceived labor and birth problems. Results suggest a need to examine how obstetricians acquire their favorable attitudes to birth technology in normal birth.”
What is happening in our medical schools and hospital policy meetings that seems to promote high rates of intervention when the research shows what we should be encouraging is normal birth? There are a number of theories for this, including the fact that OBs are the most sued medical health care professionals. Using technology means an OB can safely say and feel “we did everything we could and used every tool we had” in the event of a poor birth outcome. However, just because you CAN do something, doesn’t mean you should, or that your chances of good outcomes are inherently better because of using more technology!
There is also the human trait of being inclined to stick with what we already are comfortable with. Shifting away from the constant monitoring, away the offering of pain medications, away from watching the clock to make sure women are dilating like machines at a rate unsupported by current science is a big leap of faith in a profession that has never seen birth practiced another way.
This is not a criticism of individual hospital staff members who I truly believe are doing the best they have been trained to do. But the system, as it stands, is flawed.
I would like to see a push for our maternal health education and obstetrical practices to be driven more by what we know leads to positive physical and psychological outcomes for moms and newborns, not by a fear of getting sued or the human tendency to stay attached to status quo.
2. Getting Men Involved
Janel Mirendah, attachment therapist and filmmaker says “Fathers and partners cannot be trained or educated enough to go to the hospital to be able to “protect” their partner/wife and baby.”
Male involvement in shifting our birth culture back to normal is necessary for two reasons. First, in our fairly recent history, men have been called upon to be the primary support person for most mothers during birth. This is a revolutionary role they have taken on. Men don’t birth babies, historically they have never participated in birth, and as I often say in my Prenatal Workshop for Partners, “People barely talk to women about birth in our culture, never mind men!” We’ve suddenly asked men to step into birthing rooms and have a positive impact, usually with zero experience and very little concept of what their role is in there. Now that we’ve gotten men into the birthing scene so they can watch their babies come into the world, let’s urge them to get educated so they can contribute to a positive outcome.
Learning how to provide good support during birth, knowing how to advocate for appropriate practice from health practitioners and understanding men’s role in birth are all ways men can make a huge impact on encouraging a positive birthing experience.
There is another reason it is important that men join us in establishing positive birth practices. Medical institutions are generally thought of as fairly patriarchal systems, traditionally run by men. In the early days of birth moving out of the home and into the hospital, when we thought more intervention would improve birth, it was men who were the leaders in providing medical and technological care for birth. Although these days there are certainly a fair share of female obstetricians in practice, the over-all tone of a hospital is inherently more “masculine” than “feminine”, with a focus on monitoring, controlling and using technology to facilitate birth. The feminine, nurturing energy that traditional midwives would carry with them when they attended births in the pre-hospital-birth days is decidedly lacking. What I’m getting at here, essentially, is: “This is a masculine beast! Help us tame it, Men!”
3. Calling Out to Women
Ultimately, if we are going to promote a more positive birth culture, who we need to speak to are WOMEN. I want women to know three things: One is that there are unlimited options when it comes to birth, and that it’s your right (and responsibility) to pick and choose among them. I urge you to take the lead in your maternal health so that you can be in charge of which options are selected, as opposed to passively following a health practitioner’s orders.
Secondly, I want women to know that, despite what we are culturally trained to believe, birth is quite safe. Our bodies work just fine, and in normal circumstances we can birth babies with little more than peace and quiet as long as we’re well nourished and hydrated. If women’s bodies were so horribly incapable of giving birth without medical intervention, the human species would have died out long ago. I’d love for women to do everything we can to retrain our brains to believe that our bodies are capable of birth, designed to give birth. Personally, I fall asleep nearly every night listening to Positive Birthing Affirmations to remind myself that women’s bodies are birth-friendly. And I’m not even pregnant!
Finally, I want women to know it is always, always their right to decline medical care or intervention. There is no “my doctor let me decline continual fetal monitoring” or, “my midwife allowed me to reach 42 weeks before inducing me”. Every birth choice is yours to make, and you have every right and responsibility to make it. Side note: I want to qualify here and tell you I also believe it is your right to accept medical intervention, as I discuss in a much earlier post “Do Doulas Trust Women?”.
Women, there are more options out there for you than just hospital birth. For example, studies show that home birth with a midwife is as safe as hospital birth under normal circumstances, and that’s only in respect to ending up with a live mother and a healthy baby. My personal experience leaves me with no hesitation in saying that home birth is much more likely to leave women with more positive psychological and emotional outcomes as well. Please take the time to consider all of your options, and go with what your intuition tells you feels best.
Campaigning for better hospital birth practices can only take us so far. Hospitals and doctors are always going to want birth in their realm, want to control birth, and it seems like it will be a long time before normal birth is the norm in hospitals. It’s the nature of the system, and in spite of the best intentions of our doctors and nurses, technological birth is essentially a product that is being offered or sold. We need to appeal to WOMEN, and encourage them to stop buying the product if their goal is to have a normal birth. Again, if your choice is hospital birth with regular monitoring because that’s how you feel most comfortable (or because you or baby have a medical condition that is more likely to have a good outcome with more technological care), that’s fine! I’ll hold your hand while your midwife/doctor performs a cervical exam on the bed in your hospital room between your pressure waves or adjusts the continual fetal heart monitor belt. But if you’re a healthy mama wanting a normal birth… please, women, consider avoiding the big, mainstream supermarket for buying your groceries if what you’re craving is veggies from your own back yard. Consider home birth, mamas!
As Lonnie Morris says in the film Orgasmic Birth, “Women of earth, take back your birth.” Research your options, carefully choose who you will have attend your birth, and demand that your preferences for birthing are honoured, no matter what your chosen birth location is. Claim ownership of your body and your birth.