Why settle for ‘good enough’ when it could be AMAZING? When you really listen to women who say they had a good hospital experience they often describe some awful things, and they almost always say, “We are OK and that is all that matters,” as if they were talking about something like a car crash rather than the birth of their baby.
Women talk about trading safety for a good experience but actually, a good experience is SAFER for mum and baby, physically and emotionally, and the better a mum feels, the easier it is for her to be a caring and responsive parent. Surely that can only be a good thing? Safety and positive birth experience, the two go hand in hand, it is not a one or the other choice. A calm and peaceful birth is safer for baby, safer for mum, more likely to lead to successful breastfeeding (for so many reasons, including that stress in labour slows the hormonal start to milk production so gets in the way at the very beginning), it is less likely to result in SCBU admission, has less need for narcotic painkillers (which depress feeding and breathing reflexes in babies and can be very dangerous, even fatal), results in lower blood loss, less jaundice in babies …. The list simply goes on and on.
Women have been duped for a long time into thinking that birth is dangerous and is becoming more so, but that is spin, with no grounding in reality. Our bodies have not evolved to the point where we grown babies too big for our pelvises, nature has simply not got it wrong in the last 300 years or so. We are healthier and fitter and live longer than ever before, and we are in a better position than our ancestors to grown and birth a healthy baby, not less. It is not true that women and babies died in vast numbers giving birth prior to the advent of modern medicine. If that were true, the human race would be struggling for survival, rather than overpopulating our planet as we now are. Historical archives such as the diary of Martha Ballard (in 1700s New England) show that even then midwife-care was safe, few women died (and they did not die of childbirth itself) and few babies did either. Yes, babies who were very premature died, but sadly most still do, and of those that survive a high proportion will require life long care and suffer from brain injury. There was no antenatal screening then, nor termination for those babies who stand a low chance of survival or normal life. In recent years (since the beginning of screening and resultant termination of pregnancy) the overall number of pregnancies lost has changed little, it is just the timing of death that is changing, and the rates of cerebral palsy are not altering. Contrast that with the work of Alexander Gordon, who was vilified, lost his home, his family, his job, because he dared to suggest that childbed fever (puerperal sepsis) was transmitted by the birth attendants, and in a hospital setting there was little chance of escape. He knew nothing of bacteria, nothing of the benefits of proper hygiene, he was a long way before the discovery of penicillin, but he discovered that something they were doing was killing women and he tried to say so… His peers drove him out and it was a very long time before anyone accepted that he was right!
The things which have dramatically improved birth safety are good hygiene (things like washing hands, clean homes, flushing loos, cheap and available soap, good ventilation, reduced crowding, keeping our livestock outside) and antibiotics. The things which make it less safe are things like the loss of women’s knowledge and confidence in their bodies, a loss of family support and a cross-generational confidence in birth (where young girls know about birth from being there and they help with babycare etc.) so they don’t need specific education for it, they are just prepared. However, the biggest barrier to safety is medical intervention itself…
Lets start with position. The practice of birthing on your back is damaging to the labour process as you work against gravity, it increases pain, slows birth, restricts the pelvis, reduces blood flow to the baby, yet it is still the most common position for medical staff to encourage a woman to adopt. Staff don’t even have to say, “Get on the bed,” although they frequently do, women see birth shown like that and think it is what they need to do, they even put it on their birth plans because they don’t understand why it doesn’t help. So they get on that bed, conveniently placed in the centre of the room with nowhere else easy for them to sit, and they stay there, in increased pain, ignoring the cues from their bodies telling them to move, until someone actively suggests they try something else… If that suggestion doesn’t come, or if they are encouraged to have pain-relief and a monitor instead because they or their baby aren’t coping, then the birth becomes a medical event… When a woman puts that in her plan, staff respect it and encourage it, saying it is what she wants, but when a woman asks to remain mobile, or use water, or to do lean forwards then the excuses come thick and fast, “Just 10 minutes on the monitor first,” “the pool is in use,” “the midwife has bad knees and can’t help if you are on the floor,” and all of a sudden the birth plan is ignored and the woman is persuaded to change her careful plans. If she does not have a clued-up and assertive partner to help her, then she is very vulnerable and likely to remain doing as she is told because her brain is so focussed on labour.
Which moves me on very neatly to the second big risk factor, oxytocin. Or more to the point, all the things which stop it. Oxytocin is essential, it drives the birth process. It promotes healing, it promotes natural pain management, it promotes calm and relaxation. Not for nothing does Michel Odent call it the Hormone of Love, nor Kerstin Uvnas-Moberg call it the Hormone of Calm and Connection. It is the opposite of adrenaline, the hormone of fight and flight. The two can not run together, and so, if threatened, startled or stressed, our bodies produce adrenaline which stops the production of oxytocin until the threat is past. Since oxytocin only lasts about 1.5 minutes in our blood stream before it breaks down, the effects of its removal are both instantaneous and long lasting. It is a primal response and its control is somewhere far beyond our rational brain. So, here goes with the list of things which can increase the amount of adrenaline flooding our system and cancelling out the oxytocin which drives the process of labour and helps us feel calm, in control, free from pain and filled with love (and also ready to receive, bond with, protect, nurture and feed our baby) and safe. All things which increase adrenaline, especially those things which cause a flood, are DANGEROUS because they stop labour and they reduce the amount of blood flowing to your baby.
In no particular order:
Bright lights – light is a stimulant, all stimulants increase adrenaline, it is the first phase in how the body is stimulated.
Strange sounds – sound is a stimulant, note how you startle at a loud bang, a strange noise outside when you are sleepy, the shout of a child, a cry of distress, all those things flood your system with adrenaline. Now think about how many strange noises you are going to hear in a busy labour ward, and how many are distress calls from fellow humans…
Smell – our most primal sense. If things smell foreign they smell of danger until proven otherwise, be that potential poisons (don’t eat that, it smells off) or the smell of predator. Anything which does not smell of the safety of your own nest has the potential to smell of danger. The smell of adrenaline on those around you is a key one here… A frightened partner, a midwife who is constantly bustling and running, an over-tired doctor, the man in the room next door who has driven 20 miles flat out with his loved one in labour, not only give off physical signals of fear and distress, they really do smell of fear. Animals are good at recognising it, and so are labouring women!
Touch – calming touch, erotic touch, massage all increase oxytocin. Painful touch, unwanted intimacy (think internal exam) needles, force, lack of movement causing increased pain, all increase adrenaline. Look for the balance in a birth situation and you will see that little of the touch commonly associated with birth is calming, mostly it increases adrenaline.
Taste – allied to smell, and the reason why tea from your own tea bags, in your own mug is more soothing than any other kind…
Brain Power – when flooded with oxytocin a woman will retreat into herself. Anything which requires her to leave that state (often described as labour land) requires adrenaline to stimulate it, which means less oxytocin. Things like asking questions which require more than a grunt to answer (name, date of birth, what pain relief do you want, can we discuss your birth plan) all increase adrenaline and reduce oxytocin. See the problem and the pattern here? Moving location can also cause this, so transferring from the safety of your nest to hospital would do it. Add to that list the more complicated things, like learned fear (from hearing horror stories, from not knowing enough and not trusting our instincts), harsh words, disempowering comments, insistence on a particular course of action or insisting on something when a woman has said NO and you are flooding her with adrenaline at the expense of labour.
In the animal world it is widely accepted that anything which might stress or disturb the labour process is potentially dangerous and should be avoided at all costs, yet we expect women to cope with it, and it is because our bodies and brains are actually designed BETTER for birth than most mammals that we do birth in such stressful situations with a great degree of success and with the minimum of damage to ourselves and our babies!
So, from a biological point, well supported home birth IS safer than a hospital with all the medical facilities on hand. When it stops being safe is when hospital practices, such as lots of lights, breaking waters artificially, internal exams, lots of questions and a rush of adrenaline are introduced at home without the backup of medical expertise to rescue the situation.
This is only the start of the explanation, but it is probably enough to start you thinking and reading.