Birthing, American style


I recently watched The Business of Being Born, a documentary I got from Netflix. This was very interesting not just in an “I love anything related to babies” way but also in a feminist way. Despite my initial skepticism of the gravity of anything produced by Ricki Lake, I found the documentary worth watching. It contained some great information about birthing practices in the US.

One part that did strike a cord with me is that I have pretty much been afraid of giving birth, of being in labor, for my entire life, and apparently I’m not alone. I’m realizing this is largely because of the way that birth is portrayed in the movies and on tv. For me, I also never heard glowing birth stories from my mom – it sounded much more like an unfun experience that resulted in a very worthwhile outcome – a baby. My mother has two children (my older brother and me), and both were born via c-section. I might feel differently about it if the adult women around me had described births as “beautiful,” which is how the mom I now babysit for describes the home birth of her son earlier this year – and with feeling, like she really treasures the experience.

The film showed many powerful images of births in America both a century ago and now. On the one hand, the film showed modern women who gave birth at home, with the assistance of a midwife and their spouses and children, all of whom were close yet comfortable. On the other hand, the film showed doctors who appeared primarily concerned with getting the patients in and out of the hospital in a timely manner, and whose patients appeared, on-film, to be powerless to stop not just pain medications but also labor inducing medications, which have been shown to lead to a higher number of c-sections. At the home births, the moms looked like they were in lots of pain, but that they had support and the comfort of choosing what position to be in and possibly in a tub if they choose. At the hospital births, many of the moms looked both worn-out and uncomfortable, laying on their backs in a skimpy hospital gown. It certainly wasn’t hard to watch the mothers and know which situation seemed like a more comfortable, loving, bonding experience for the birth of a child, although I was left wondering more about birthing centers, which seem like they might be the best of both worlds.

The Huffington Post featured a recent article on the AMA’s response to the documentary:

Ladies, the physicians of America have issued their decree: they don’t want you having your babies at home with midwives.

We can’t imagine why not. Study upon study have shown that planning a home birth with a trained midwife is a great choice if you want to avoid unnecessary medical intervention. Midwives are experts in supporting the physiological birth process: monitoring you and your baby during labor, helping you into positions that help labor progress, protecting your pelvic parts from damage while you push, and “catching” the baby from the position that’s most effective and comfortable for you — hands and knees, squatting, even standing — not the position most comfortable for her.

When healthy women are supported this way, 95% give birth vaginally, with hardly any intervention.

And yet, the American Medical Association doesn’t see the point.

Although I can easily imagine wanting an epidural or some type of painkiller, I wouldn’t want an episiotomy, inducing drug like pitocin, or a c-section unless it was medically necessary. Unfortunately, even just taking an epidural can make you more likely to need any/all of those three. And the c-section and episiotomy both feature weeks to months of recovery which can inhibit your opportunities for baby bonding and for sexual relations with your husband. (Months of sex being painful while the episiotomy heals? No thanks!)

And the information suggests that for women with a low-risk pregnancy, they’ll have a lower incidence of these procedures being performed if they birth at home with a midwife. A study published in 2005 concludes:

Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

And then there’s this part, from the blog by the author of the book Pushed: The Painful Truth About Childbirth and Modern Maternity Care:

Pitocin, given to more than half of women during labor, is the synthetic preparation of the hormone oxytocin, the driving force of labor that causes the uterus to contract. You know the soft side of oxytocin already: it floods your body during orgasm, when you fall in love, when you get close to a friend, even when you sit down to a shared meal. It is the hormone of connection, closeness — love. And when women give birth, they get the biggest helping of oxytocin that humans ever experience. A “love high,” if you will.

Pitocin replicates oxytocin’s muscle, producing strong uterine contractions, but it does not pass to the brain. You don’t get the warm and fuzzies with the pharmaceutical version. Furthermore, it shuts down your body’s own oxytocin production. That means that when you get Pitocin in your IV — whether you’re being induced or just “augmented” — you’re missing out on the natural oxy-rush.

If any woman is going to go through labor, it certainly sounds like it’d be a lot more enjoyable of an experience with the natural oxytocin rushing through your body and priming you to bond with your baby. Seriously. The most oxytocin humans ever experience? Where do I sign up?!

So, for the moms among my readers – what kind of birth did you have, and how do you feel about the experience?

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12 thoughts on “Birthing, American style

  1. Considering that child birth is a relatively dangerous thing for humans – compared to other mammals – I was determined to give birth in hospital where I could have access to pain relief and medical intervention if needed. The laughing gas did an awesome job of reducing the most intensive pain and I’m not sure how well I would have done with an almost three-hour final push phase at home. I would certainly use the hospital again next time – if there will ever be a next time!

  2. I also gave birth in the hospital, for the same reason as hypoglycemiagirl. If something goes wrong, a hospital is a good place to (already) be.

    My water broke before I got to the hospital, and when that happens, they automatically give you pitocin because you’re open to infection and there’s now a time limit before the baby has to come out. So I don’t know about the causality of pitocin and C-sections. It could be that people whose water breaks first (for example) have a high rate of pitocin *and* C-sections, rather than pitocin causing C-sections.

    And pardon the language, but it fucking hurt to give birth. I had never been in so much pain in my life! This was attributable to the pitocin. I had planned to have an all-natural birth but that plan was quickly shelved when I experienced the wracking pain. I had an epidural and it *still* fucking hurt, but not nearly as bad as it was hurting before the epidural. I’d never heard about the natural oxy-rush — but that must explain why so many mothers somehow forget the pain of childbirth. I still haven’t forgotten, so no new pregnancy for me yet.

    My hospital room was very nice — it was private, with an attached bathroom with whirlpool tub, and enough room for my husband to stay. The baby was in a rolling crib. Knowing what I now know, I think I would take him out of that crib and have him sleep on me instead. But it was a pleasant place and I preferred to give birth there rather than at home, where I would feel paranoid about the cleanliness of my house and embarrassed at others seeing the mess.

    As for the post-partum period and sexual relations — of course it is different for everyone. I did not have an episiotomy but I did tear pretty badly and I am still recovering from the tearing. I had surgery in March to remove some of the really painful vascular scar tissue I developed. But even if I hadn’t had those problems, I really didn’t want anybody touching me for at least six months. My husband would just touch my shoulder and I would recoil. It is taking a while for my intimacy levels to get back to normal.

  3. I gave birth almost 19 years ago. I was working in a hospital in the Ob/Gyn department at the time so I gave birth there. Didn’t think of doing it any other way. I was young and healthy. I had an epidural but no other drugs. I did not have an episiotomy but I did tear a bit.

    Contractions were incredibly painful until I got the epidural. Then I could relax and rest. It wore off before I pushed and that was the most intense and painful 45 minutes I’ve ever endured. Afterwards I felt the most amazing sense of relief and it was a high but not a love high. That came much later when I was finally alone with my son in my room.

    My husband and I started having sex again as soon as it was “medically allowed,” I think 6 weeks. I did not have months of painful sex, although that first time was not the best. My sex life changed because I was exhausted staying up with a newborn and having to go back to work when he was 8 weeks old not because of the birth experience.

    I don’t know how I would do it now, if I was young enough to even consider pregnancy. I’ve heard so many excellent accounts of home births with midwives that I think I would seriously look into that.

  4. Unfortunately, I chose to birth my first baby in the hospital. I had attended a home birth of a friend and yet still carried that American fear of birth. I was determined to have an “all natural” birth in a hospital because of how much better it is for both mom and baby during and after the birth. However, I was started on an IV with saline, told I couldn’t eat, started on pitocin, put in the supine position for pushing, continually asked if I wanted an epidural, continually given vaginal exams, etc. I fully dilated and effaced in just 7-8 hours and after almost 2 hours of “on demand” pushing my OB comes in saying we need to do a cesarean. Mind you, there were no decels, my bp was fine, nothing emergent was happening. It was the traditional FTP (failure to progress) diagnosis. I now had all of the recovery issues and future risks associated with major abdominal surgery. I could go on and on about the awful experience forced on me, but to keep this short I’ll just move on. My second baby was a repeat c/s due to my OB warning about how I might end up with the exact same scenario and possible die from trying VBAC (he apparently hadn’t read the 2006 Landon study with EXCELLENT outcomes even for moms with 4 prior cesareans).

    So, in 2008 (yes, just a few months ago) I had finally evolved as a thinker and decided to fully investigate ALL sides to birth. I joined birthing communities, read about both the amazing outcomes and the sad outcomes (to see if there was anything a hospital could have done in those rare cases). I regained a faith in my body and in what God created it to do ESPECIALLY when left alone. I was stunned by how much women have learned to rely on a hospital “just in case” of an emergency. And yet, because of that decision, most women are pushed into a cascade of interventions (pitocin, epidural, on-demand pushing, oxygen, forceps, etc.) that lead to sometimes life-threatening outcomes by themselves (cord prolapse, horrible vaginal tearing, poor fetal positioning, decels in baby, high bp in mom, etc.). My husband, a college professor, wasn’t supportive of home birth in the beginning. Not at all. But he began reading tons on his own during my pregnancy–studies, books, personal stories, etc. He couldn’t stop talking about it–and low and behold HE was the first to suggest that we birth out-of-hospital this time. He wanted a healthy wife and mother this time around. He also discovered that he had bought into the whole “just in case of emergency” birth fear by relying on OBs to “save” us and missed that most any emergency could be discovered by an attentive midwife in plenty of time to travel to a hospital. We also learned TONS about CNMs (certified nurse midwives) and CPMs (certified professional midwives) and DEMs (direct entry midwives)–particularly what they do in the event of an emergency (i.e. administering pitocin/cytotec to stop a hemorrhage, perform infant CPR, give oxygen to baby or mommy, etc.). And, I’m happy to say, that I fired my OB at 37 weeks pregnant and found the most amazing CNM midwife to deliver our VBAmC baby just a few miles down the road from a fully-staffed hospital. Because of laws in our state, we had to drive across TWO state lines to get to her house to birth. But I would do it again in a heartbeat!

    The experience was beyond my wildest imagination. I’ve written a full account of it (http://www.millermemo.com/BrightonBirth.html) so I won’t reinvent the wheel here, but I can say that if I had experienced such a perfect birth with my first, I might have had 10 babies as a surrogate mother for others who cannot have babies. It was amazing to just allow my body to do what it does best–what my body was created to do. I still think a hospital birth is good for those with serious health issues and for emergency situations that arise, but for a healthy mom with no fetal health concerns, I would never ever suggest a trip to the hospital unless something out-of-the-ordinary is detected by a trained midwife. Birth is a physiological occurrence when left alone and simply monitored. We have a greater risk of dying from a FATAL car wreck in the next year than of having a death from a natural birth. But we still drive cars, don’t we? It’s socially acceptable and considered a necessary risk.

    Unfortunately, thousands of women each year face invented birthing emergencies due to routine interventions. I can’t say enough about this phenomenon. It wasn’t surprising to me, at all, to hear OBs on the movies Business of Being Born and Born in the USA talk about being taught, in med school, to do a c/s whenever it could be justified. Like they said–it’s just 20 minutes and they’re home in time for dinner. Yep, mine happened just after 6pm. 😦

    Thanks for doing this post. It’s wonderful to be questioning the system and asking the tough questions. I’ve now come across three public letters from OBs upset with ACOG for their recent unfounded statement on home birth. And these are just the doctors who are making their letters public. Who knows how many are writing private letters. I’m actually thankful that this whole issue is being brought up because it will, hopefully, get our young women (and men) thinking about this and considering all options before it is their time to give birth.

  5. My middle sister was delivered by a midwife, but in the hospital She was absolutely wonderful, and I’m sure that she didn’t offer any unnecessary interventions. My youngest sister was delivered by our family doctor, who no only knows us all well but who also is very hands-off, and I think my mom ended up with an episiotomy.

    In Cold Utopia there’s a birthing center (midwives!) that’s about 15 minutes from the nearest hospital. Their website says they call ahead for transfers and the time to emergency C-section is about the same as it would be if you were in the hospital. Next step: finding out if our insurance will (eventually, one day) let us go there!

  6. We can handle more pain than we think. I had a totally manageable labor in terms of pain until they gave me pitocin. Pitocin was deemed necessary because too much time had elapsed after my water broke before labor kicked into high gear. Before pitocin, contractions came and went and it’s not that they didn’t hurt, but there was a rhythm I could get used to. I knew they would come and go and the breaks were just enough of a rest. Once pitocin was involved, however, there was no pause between contractions and I couldn’t hack it, so I ended up having an epidural. The epidural was fabulous. I could feel the contractions, but not the pain. It didn’t seem to affect me mentally in any way and it enabled me to get some much needed rest (I was in labor for something like 26 hours, so some sleep was in order). People talk a lot about the pain and I don’t want to under-represent it, because labor is all about pain response, but it’s not what I took away from the event at all. Giving birth was the single most intense and wonderful experience of my life, hands down. I spent days running the whole chain of events over and over again in my head, unable to quite process it. I tried to write it down,desperate but it wasn’t something I could easily put into words. It was beyond words. And somehow the sense of the miraculous was only intensified by the knowledge that it was basic biological function, the most mundane of events…and also the least. I guess what I’m trying to say is that although there is certainly pain involved, there are many other, much more positive things as well, all equally, if not more intense than the negatives. I think we do ourselves a disservice to obsess about the pain part. There is much more too it. And also, I think as a culture, we don’t handle pain very well. We think of it as something to be cured or fixed. But pain is often a necessary part of growth or change, even for the best of reasons. And maybe to think of it as something to accept and work with is better than trying to steel ourselves against it in advance.

  7. I forgot to mention that I gave birth in a hospital under the supervision of a doctor who was in a practice with midwives. I was on the older side (33) and we had had some abnormal prenatal tests (it turned out to be nothing), so I wanted to be at a hospital in case anything happened. I didn’t even consider a home birth. If I were doing it all over again, I would actively seek out a practice with both doctors and midwives if you can find one. The mix of approaches were great. And the kind of doctors who go into practice with midwives is the kind I like — more attentive to the whole patient, not just on her medical chart.

  8. Yeah.. I have to say, hospital is the way to go. The thing is, you never really know for sure how the birth will go until it starts. I can think of several close friends who ended up having surprise emergency c-sections, and basically, if they had had to try to run to hospital when it became urgent, the baby would have died by then. Childbirth is still one of the leading causes of death for women without access to modern medical care… so even if aspects of being in hospital are unpleasant, I would still rather be assured that myself and my baby have the best chances for survival.

  9. I had a hospital birth with my first and a homebirth (with midwives) for the second. While both were ‘natural’ births, they were very, very different experiences. The home birth was something that I think every woman should experience, if she can. Yes, there was [significant] pain, but it was productive pain. It wasn’t scary (at all, ever). Things weren’t out of control. It was my body, doing what it was designed to do, and *me* doing it all. Truly amazing and empowering.

    Regarding the risks/dangers. Our midwives have an OB backup (I had one prenatal visit with him). If ‘something went wrong’, we would have called the OB and the ambulance and transferred to the hospital that was 10 minutes away. And the midwives are trained and there to know when things aren’t ‘right’ — they want a good outcome too! For a healthy, non-complications pregnancy, home births have better outcome statistics (re: interventions) than hospital births.

    I recommend Ina May Gaskin’s book on natural births.

  10. I’ve also had two births – one in the hospital (unmedicated with midwives) and one at home (also unmedicated, but midwife didn’t make it in time). In addition, I work as a doula for hospital births and midwife’s assistant for homebirths. In a way, I consider myself a secret shopper of birthing locales in our city (Chicago).

    The biggest difference I see between the two settings is the respect and autonomy given to a mother. Very often in hospitals, the mother is a passive vehicle for the baby’s birth. She is a liability and is viewed as a dangerous encasing for her baby. They do anything they can to get that baby out of her insidious body, including using medications that aren’t approved for use during pregnancy and labor and utilizing practices that are PROVEN to be detrimental to the health of both baby and mother. It seems that liability rules obstetrics more than true healthcare (the sad case of our entire society right now, huh?).

    At home, the mother is in charge and she is the one calling the shots. The pain tells her what positions will help the baby navigate its passage; her intuition is her guide. She is surrounded by people who acknowledge that SHE will birth the baby, not just hold it in her body until it is forced out. That support can not be underestimated, for the fear or the love around her dictate which hormones will flood her body – the ones that cause progress or hindrance to labor (oxytocin or adrenaline). This is also why the presence of a doula at a hospital birth can improve outcomes so dramatically – she helps the woman feel safe. Perhaps she has a trained attendant present, who can foresee if the birth veers from normal. (And that’s an important point when discussing the “safety” of homebirth. Deviations from normal are rarely emergent, but show themselves long before they are a true risk. Then it’s time to transfer.) Of course, some women choose to birth at home unassisted, perhaps because they feel safest alone or because they can not find a provider they trust to enter the space without disrupting it.

    I am making generalizations, of course. Not every homebirth midwife has confidence in the process and not every hospital-based care provider is waiting for the woman to explode. These are broad observations I’ve noticed in my own experience and as a doula.

    Both of my births were incredible, empowering events. But how nice it was not to leave my house in the middle of labor and how wonderful to not worry about postpartum protocols from nurses who just want to get through their shifts (just my experience in that particular hospital). The midwife I assist tells me that in England midwifery care is not limited to location, but they decide during labor whether the woman would rather stay at home or go to the hospital. I love this idea because how can you know what will be right for you until you’re doing it for the first time?

  11. I was in labor with my son for 54 1/2 hours, even with the help of the hospital. The back labor was much worse than the active labor pains, but combined the pain was excrusiating. My time in the tub was my only relief from the back labor, which allowed me to breath through the rest of the pain. If they’d let me I’d have been in the water the whole time. Often I wonder if the moniters and all the other interventions made my labor more difficult and longer than it had to be.

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