|Having Babies - Home Births with Midwives
By Darrel Crain, Doctor of Chiropractic
We have a problem with having babies, according to Sam Levenson, "Somewhere on this globe, every ten seconds, there is a woman giving birth to a child. She must be found and stopped."
I wonder though, is the problem with the babies, or with our birthing habits?
My first experience with hospital births happened when I was born. That was in the Arlington Hospital in Arlington, Virginia way back in 1954.
Things were different back then. The nurses didn't even ask my parents if they wanted the hospital staff to whack my wee-wee, they just whisked me off and cut, cut, cut! It was as automatic as slapping me on the behind.
"What's that little bandage there on my baby with the blood on it?"
"That's where we whacked your son's wee-wee, you know, circumcision."
"Oh! How come you did that?"
"Because we always do!"
"Ooh! Yuck!" And so on.
Then the nurse carried me off to a sterile, white, fluorescent-lit isolation ward hilariously referred to as a nursery. The room was full of little plastic boxes full of brand new babies wrapped-up in little blankets, all of us wondering what in the heck just happened.
I'm told they occasionally let me out for good behavior to see my mom, but only at feeding time. When that was done, they scooped me up and hustled me back to my plastic detention chamber. Where was my mama? Where was the warmth and how come I couldn't hear that steady heartbeat I had been listening to my entire life so far?
Things were definitely different back when I was born. Dads didn't even think of asking to come into the delivery room, much less expect they would be invited inside. I'm told we've come a long way since then.
For example, hospitals let dads into the delivery room nowadays to watch the birth and experience feelings of awe, spiritual mystery and complete helplessness. And circumcision was eventually recognized for what it always was, a cultural habit inappropriately assigned medical and hygienic importance.
Speaking of hospitals, I was recently invited to join a committee formed to improve medical services out here in the backcountry. Really important people were at the meeting, people from hospitals and clinics, people with power, rank and influence. And there I was, the symbolic "alternative one," the non-medical doctor probably added for comic relief.
Mostly we talked about how far people had to drive to get to the hospital and problems with funding new hospitals and clinics and overcrowding in the hospitals and clinics already in operation.
One idea came up during the meeting that made a lot of sense. What about creating freestanding birth centers out in the backcountry? Wouldn't that save moms from driving more than an hour to the hospital, save money, and free up space in the hospitals that were already too busy?
The idea was dismissed with zero discussion, as if someone had suggested we contract with Santa Claus for all future emergency transport using only his sleigh and reindeer.
"Nope, can't be done," all heads shook at once. "Not profitable," they said as one.
Not profitable? I left the meeting wondering how that could be? I knew for a fact that the cost of having a baby at a freestanding birth center was at least a third less than a hospital birth. And home births with midwives cost nearly two-thirds less!
Perhaps they missed this report: "$13 to $20 billion a year could be saved in health care costs by demedicalizing childbirth, developing midwifery, and encouraging breastfeeding," according to Frank Oski, M.D., Director of the Department of Pediatrics at Johns Hopkins School of Medicine. Isn't saving money profitable?
Midwives, of course, have been delivering babies since time immemorial. As Dr. Sarah Buckley pointed out, "Women's bodies have their own wisdom, and a system of birth refined over 100,000 generations is not so easily overpowered."
But that doesn't stop people from trying. Non-medical births are publicly scorned as being outmoded and dangerous, while hospital-based births are touted as safer with better outcomes. Why is this message endlessly repeated despite a flood of evidence in the medical literature saying this just isn't so? Midwife-attended births for low to moderate risk pregnancies (the majority of pregnancies), whether in the home or in birthing centers, are amply demonstrated to be at least as safe as hospital births, and probably safer.
Cordelia S. Hanna wrote of The National Birth Center Study, published in the New England Journal of Medicine in December 1989, "...about 15 percent of women who begin labor in a freestanding birth center require transfer to an acute care facility, while only 2 percent require emergency transfer. The others were mainly transferred for slow progress or because the woman requested anesthesia. The overall cesarean section rate was 4.4 percent."
This brings up an impressive distinction of births in non-medical settings. Not only are they safe, but the number of invasive medical interventions required to get the job done falls dramatically when midwives are in charge.
A woman giving birth in a hospital is much more likely to have an epidural, a cesarean section (c-section), a vacuum extraction, an episiotomy (the surgical cut to enlarge the vaginal opening), receive pitocin (a synthetic hormone to induce labor or else kick labor into high gear), and be strapped down with an electronic fetal monitor and a catheter so she can't move.
As Ogden Nash put it, "Progress might have been all right once, but it's gone on too long."
Each of these interventions has a tendency to be iatrogenic, meaning the doctor's action causes a new complication that interrupts the natural progression of birth. This creates an essentially preventable cascade of additional medical interventions with ever-increasing risk to both mom and baby.
The average C-section rate in hospitals across the United States by 2004 had climbed to 29 percent. That's almost a third of all births, though in some states, such as New Jersey, the C-section rate exceeds 40 percent! The assurance that this is simply the modern method of birth preferred by modern women is starkly unscientific and opposes evidence-based medicine.
Medical leaders must be reminded over and over that the infant survival rate in the United States is atrocious, worse than just about every other industrialized nation in the world. In this context, every single medical intervention during birth and immediately after is unavoidably suspect of contributing to our abysmal infant mortality rate. This includes every medication, diagnostic procedure and vaccine.
"Obstetricians and hospitals have found that high-intervention birth, warranted or not, is very profitable..." said Tonya Jamois, president of the International Cesarean Awareness Network.
Finally I understood why the idea of a low-tech, low-cost birthing facility in the backcountry was greeted with indifference: not-for-profit hospitals base their decisions on profitability, and a freestanding birth center run by midwives would be just too low-intervention to be profitable.
Solving complex problems requires thinking outside the box; in this case, outside the hospital – perhaps inside homes and birth centers. How can we plan and fund facilities, transfer systems and public education programs that reflect the requirements of healthy birthing, the universal and natural experience of bringing a child into the world? How can we support the training and licensing of more midwives and expand the influence of that remarkable and timeless profession?
Carla Hartley, founder of Trust Birth, pinpointed our dilemma, "We've put birth in the same category with illness and disease and it's never belonged there."
Do you suppose it would help solve our serious hospital crises if we separated out normal physiological events, such as birthing, that are currently treated as if they were emergency, life-threatening operations? The medical mantra, "That's what we always do!" simply does not cut it any more, literally.
© Darrel Crain, 2006 All rights reserved.
Comments? Questions? Opinions? Rants? Call Darrel Crain at 619-445-0100
Dr. Darrel Crain
Natural Health Writer
President, CCA San Diego County District