When I was pregnant with Hooper, my midwife palpated my belly. Her eyebrows raised and a look of surprise came over her face as she proclaimed, “he’s a long boy!”. Fast forward to his birth, where he measured 23 inches. She nailed it, he was a long boy. And that’s just one of many things I love about midwives; they use and trust their hands.
When I went to see my new backup OB, he confessed that he cannot tell the difference between a babies rump and head when he is palpating a woman’s pregnant belly. He also confessed that although he wears one of the most expensive stethoscopes around his neck, he hardly ever uses it and cannot tell the difference in various heart rhythms. Instead, he said, he relies on ultrasound for detecting the baby’s position and an EKG to determine heart rhythm. He’s young and he’s the product of modern day machinery, I mean medicine.
At any rate I recently read a fascinating article, “The Most Scientific Birth Is Often the Least Technological Birth”, written by Alice Dreger, a professor of clinical medical humanities and bioethics at Northwestern University’s Feinberg School of Medicine. She starts the article by sharing the answer she received when asking her medical students what came to mind when they envisioned someone who chose a midwife over an obstetrician. The students described a granola girl. You know, they one’s that look almost Amish and frolic in fields of grass and mix herbs from their gardens in their spare time.
I don’t consider myself a granola girl at all, in fact, I’m slightly offended when someone refers to me as a “hippie” because I’m choosing a home birth. Instead, I consider myself very rational. I also find myself to be a hostage of my own principles. It’s nearly impossible for me to do something I don’t believe in. And I do believe in medicine, otherwise I would not work at a large hospital as a registered nurse. But I believe their is a time and place for medical intervention.
Dreger goes on to make a clear differentiation between science and technology, noting that the scientific literature shows that interventions used during birth actually increase the risk to mother and child instead of decreasing it. A bold statement made by someone both in the academic and medical worlds, no? She states the problem with her medical students is that they think that what it means to be a scientific doctor is to bring to bear the maximum amount of technology on any given patient. And this, she says, makes them dangerous.
It goes without saying that all woman want a healthy outcome when it comes to birthing their child. The problem today, she says, is that no one seems to tell them what the data indicates is the best way to get there.
Recounting her own pregnancy in 2000, she says:
“My mate and I consulted the scientific medical literature to find out how to maximize safety for me and our child, here’s what we learned from the studies available: I should walk a lot during my pregnancy, and also walk around during my labor; doing so would decrease labor time and pain. During pregnancy, I should get regular check-ups of my weight, urine, blood pressure, and belly growth, but should avoid vaginal exams. I should not bother with a prenatal sonogram if my pregnancy continued to be low-risk, because doing so would be extremely unlikely to improve my or my baby’s health, and could well result in further tests that increased risk to us without benefit.
According to the best studies available, when it came time to birth at the end of my low-risk pregnancy, I should not have induction, nor an episiotomy, nor continuous monitoring of the baby’s heartbeat during labor, nor pain medications, and definitely not a c-section. I should give birth in the squatting position, and I should have a doula — a professional labor support person to talk to me throughout the birth. (Studies show that doulas are astonishingly effective at lowering risk, so good that one obstetrician has quipped that if doulas were a drug, it would be illegal not to give one to every pregnant woman.)”
Drawing from several experts in the birth world, Dreger points to the problem in the way birth is conceived in America — as “dangerous, risky, and in need of control to ensure a good outcome.” She also touches on the lack of insurance coverage for births outside of the hospital setting, the misuse of science to support the new technologies of birth, the lack of information provided to woman regarding the dangers in interventions offered, and the limited options women in America have in regards to bringing their child into the world.
I had to fight hard for home birth coverage. I wasn’t even aware that coverage could have been obtained the first time around and thus had to pay out of pocket for something that in hindsight could have been covered had I had more knowledge or had someone presented my options to me. Instead, obtaining home birth coverage was something I did proactively. I made home birth an option for myself, no one presented it on a silver platter. It’s unfortunate because I know a lot of women don’t have the time or energy that I did to put toward it, even if our desires for the best birthing outcome are the same.
Dreger concludes by stating, “We’re all very interested in having healthy babies and it is pretty easy to make the kind of cognitive errors that people make, and attribute to technology benefits that don’t exist. At the same time, when there are problems in a pregnancy, that very same technology can be life-saving. It is easy to make the [problematic mental] leap that technology is always going to be necessary for a good outcome.”
I get that this is a touchy subject. You can check out the comments to her article if you really want to get fired up one way or the other. I get that a home birth is not for everyone. I get that a natural birth is not for everyone. I get that some women are more comfortable birthing in the hospital setting and I get that some prefer an Obstetrician to a Midwife. But my bottom line has never wavered: Women need to be educated. The consequences of many of the interventions throughout labor need to be discussed and options need to be more available.