Birth notes

You aren’t going to think less of me if I can’t do this by myself?

Back in November, I was going to write an article for the Big Bad Blog about the week during which Maggie was born. The problem was that I did not intend to write a chronology, but about some of the things that bothered me in the lead up to Maggie’s birth, and the insight that crystallized over the course of the week. The final and most profound moment for this was when Karen said the words above, or something like them. This was the last gasp of our approach of “doing things naturally”. Avoiding painkillers was abandoned in favour of accepting the help and expertise of people who dedicate their lives to helping women in labour, and do their best to make them comfortable and safe.

The moment in which I realized that all those blog articles and books that push an agenda of avoiding doctors and pain relief on women are not encouraging them to take control of the situation, but often actually counsel them – perhaps not intentionally – to avoid help. We would not dream of raising Maggie without the help of family, teachers and doctors. Why would we want to be so stubborn about her arrival?

My planned article would lack impact, I thought, if people lacked the full story. The story was Karen’s, and I waited for her to blog it, herself … but said blog never arrived. I soon realized that Maggie would not allow the time for it, and filed my article under “contemplated, but never written.”

But occasionally I read something that triggers a huge amount of anger. Last week I read this article by Mayim Bialik which was sufficiently triggering for me to write this.

Bialik is not just your average 1990s television star to find a bit part on a much better television show twenty years later. Between the two, she studied neuroscience and received her PhD. This suggests that she ought to have some well-developed critical thinking muscles. And this is, I think, part of the trigger for me. It is not just another article — it is written by a celebrity, published by MSNBC, and stamped with the three letters “PhD” after her name to lend authority.

Not that expertise in neuroscience gives insight into birth, but … there you go. Bialik makes a series of statements that hurt my head, and make me angry. Initially, I was going to rebut the article point-by-point, but after typing a couple thousand of non-constructive words, we have decided to touch on the one thing that angered us the most, and then try to move on quickly to more constructive writing.

The pain

While Bialik’s strange desire for the safety (and society’s sexual stratification) of the early 1800s left us aghast, and her describing precaution as hysteria-inducing — yes, she used the word “hysteria” — was baffling, it was the alleged logic surrounding her rejection of anesthesia that really got me fuming, and brought Karen’s words at the hospital back to mind.

Here at the Big Bad Blog, we are of the opinion that drugs should be the bastion of last resort. It is unquestionably healthier to avoid drugs (and their potential side effects) while other means of pain relief are exhausted. But Bialik goes further than this when she states that she is against medicating for the emotions of birth (her words, not mine).

She does not appear to recognize physical pain, or the difference between physical pain and emotional pain. Instead, this Doctor of Neuroscience tells her readers that if they take medicine for the pain, it will dull the emotions of the experience.

Bialik is practically telling women to accept the pain, or risk the emotional bond they have with their child.

To top it all off, she suggests homeopathy — water that is supposed to remember things and have magical properties as a result — as a potential pain relief option.

Physical pain and emotional pain are, of course, two different things. None of the drugs offered at the hospital for pain during childbirth are anti-depressants (to my knowledge), and suggesting otherwise is bizarre, off-the-wall, and makes me wonder where she got that from. Citations are absent, of course. I speculate that they are non-existent, but cannot, unfortunately, prove such a negative.

You probably don’t think less of me for taking ibuprofen and a muscle relaxant the other night, so I might sleep through back pain. You probably don’t think less of yourself for having an anesthetic during dental work.

Karen practiced techniques from Juju Sundin’s book for months before the pregnancy, every night. The techniques were fantastic, and worked very, very well — we highly recommend the book — but after sixty hours of regular contractions, they weren’t enough anymore.

Strangely, we love Maggie anyways, and Maggie loves us. This is not because we were lucky that pain medication did not lessen our emotional bonds, but is instead because pain medication does not impact emotional bonds in the way Bialik’s language would suggest.

The points that should be made

With that behind us, we will now try to move on to writing something constructive about the subject. It would be nice to see some sort of article that actually makes important points to people who are planning to have a baby outside the hospital.

The article I have in mind would be well-researched. This is not, however I did do a boatload of research a year ago, when exploring our options for Maggie’s birth. Here is some advice gleaned from having been down this road before:

Make sure your midwife is qualified

Who certifies midwives? Does your midwife have the appropriate certification as a medical professional? In the UK, most midwives work for the National Health Service (NHS), which presumably only employs certified doctors, nurses and midwives. But if you are hiring somebody privately, you should make sure they are qualified.

We are under the impression that, in the United States (which is the source for most of the traffic to the Big Bad Blog), untrained and uncertified midwives are — for reasons unknown — allowed to call themselves “midwives” and deliver babies in people’s homes. We would recommend that you stick with the certified variety.

Make sure your Midwife is insured

Here in the UK, there are both public and private health options. Private midwives in the UK are unable to get insurance. This means that insurance companies have calculated the average payout they would have to make per midwife, added enough to cover their costs (lawyers, actuaries, etc.) and a tidy 10% profit … and came up with a number so high that it was not worthwhile to sell to private midwives.

Insurance companies are essentially professional risk assessors who care only about profit. If they refuse to insure somebody, or price the insurance so to be impossibly expensive … that tells you something.

Make sure your midwife is connected

One of the great things about the UK is that the midwives work for the NHS, and are part of the same system. Our GP’s clinic has a midwife’s office in it, where Karen went for most of her pre-natal checkups. They are connected with the birthing centre, where we planned to have Maggie, and the hospital, where we went for ultrasounds, and where Maggie was ultimately born

All of them, part of one system, acting in concert.

It is easy to have confidence in the birthing centre, when it is attached to a hospital that has amazingly high success rates for live births (“success” meaning a mother and baby who survive the experience) … and does not consider the birthing centre to be a separate entity.

You should make sure that you have the same thing.

Not necessarily an NHS, of course — that might be a bit much to accomplish in nine months, while pregnant — but all your care providers need to be working in concert. They need to know how each other work, and hand everything off smoothly. They need to have a protocol, and be comfortable with each other.

It’s no good to have your midwife dump you in an ambulance, heading to the hospital, if things go wrong. She needs to be linked to the hospital. They need to know you’re coming, and be ready for you, knowing exactly what has gone wrong.

This, to me, seems to be the biggest trouble in the United States with midwifery — from what I read, this relationship is rare. There is no way that home birth — or even a birth centre birth — is safe without it. It would be like driving without a seat belt.

Have a contingency plan

As much as her article as a whole rubs us the wrong way, we agree with one of Bialik’s axioms: Giving birth should not be treated as an accident waiting to happen.

The medicalization of birth has been a wonderful thing. It has made the process so abundantly safe that people like Bialik can claim — without sounding foolish — that we would be better off in our living rooms without any medical people present. To welcome the child into our world, surrounded by our things. When the child has arrived, we want her to have arrived home, instead of having arrived in a place most of us prefer to avoid.

And those things would be wonderful, and women should strive for them.

At the same time, anybody with any sense makes contingency plans. As a fencing coach, I never planned my practices as an accident waiting to happen. As a tournament organiser, I never planned a tournament as an emergency waiting to happen. But I always had a plan in case it did.

Looking after the students/competitors. Calling the ambulance. Giving directions. Where would the ambulance arrive? What is the shortest path to the gym? Failure to make such plans is negligent and ensures that there is never an emergency: either everything goes as planned, or there is tragedy. The danger in saying “birth should not be treated as an emergency” is that people might read “full stop” at the end of the sentence.

Have a contingency plan. Know the contingency plan. Make sure your health providers know the contingency plan. Being prepared for the worst is different than assuming that it will happen. If you have good health care providers, they will probably already have one drawn up, know it by heart, and give it to you when you broach the subject.

Bridging the divide

For some reason there seems to be a war on out there.

There are people who insist that childbirth should be “natural”. By which they mean not-in-a-hospital. And free of intervention, by which they mean free of the-interventions-that-they-don’t-like. Bialik, for example, thinks that pain relief is bad … unless the pain relief happens to be baths, hypnosis and homeopathy.

The reaction to this from critical thinkers and medical professionals (who are not, unfortunately, all critical thinkers) is to take the other extreme. Ignoring the actual source of the desire for a “natural” experience, and the reason for the resonance of the “natural” approach, they extoll hospitals for their success rates (where “success” is measured in the resulting alive-ness of mother and baby). They become even more clinical in an attempt to prove their superiority.

The actual issue of course, is not that women want to return to nature. It is that the doctor does not have a relationship with an expectant mother, but with his or her patient. Years of medical training teaches doctors to view them this way, and the environment – a hospital – only serves to exaggerate it. On the other hand, the mother/midwife relationship, in the home or a birthing centre, creates an entirely different sort of atmosphere.

Doctor/patient relationships usually resolve around two archetypal interactions: identifying and resolving health problems (an interaction which dominates at the hospital), and the mitigation of potential future problems.

But the pregnant woman defies these conventions. She does not have a broken leg or ruptured spleen – her pregnancy is not a problem. Her child is not a potential problem to be mitigated. When she steps into the medical world, however, she gets forced into its paradigm — the pregnancy is viewed as a condition. The treatment culminates in the removal of the baby from the womb.

Instead of sniping back-and-forth about things that are not an issue for anybody but the most hardcore fanatics on either side of the debate, it would be nice to see people recognize the actual issue and move towards a resolution that can capture the safety of a medicalized birth, while removing the associated paradigms that focus on pregnancy as though it were a condition to be treated.

In the UK, the NHS is making some headway here — the birthing centre that we (almost) used is a great example — but I do not think they understand the problem. It is simply a government agency responding to the natural birth lobby while attempting to minimize liability.

Imagine what could be accomplished if the real goal – birth which is empowering, comfortable, and safe – were recognized.

6 thoughts on “Birth notes

  1. Brilliantly written. Man, I don’t understand the insanity of the natural birth lobby to the dereliction of health and safety for both mother and child.

    1. I do — to them, it’s not at all about health or safety. It’s about control.

      The medical community has become so good at making birth safe that it’s hard to imagine today how dangerous it was to give birth back when our grandparents (or even our parents) were born — the ultrasound, for example, is only about fifty years old.

      But the traditional medical birth experience is about a team of physicians getting the baby out safely. It’s a hell of a way to invite a little person into the world, and I think it’s a normal reaction for people to want to do it in their own way. As much as having a little baby poop on me in an operating theatre was a magical experience, I would wish a slightly less harrowing experience upon others.

      The problem is that there’s a group that’s all about risk management, and (it sometimes seems) couldn’t give a damn about what the mother wants or how she feels. And there’s a group that (it sometimes seems) doesn’t give much thought to risk management, so long as the mother feels empowered by the experience.

      The right path lies somewhere between these extremes. As is usually the case.

  2. Well said. I got denounced by the midwife in front of my whole ante-natal class when she found out I was having a c-section, nevermind that this would ensure both the survival of my son and the continued structural integrity of my pelvis, as Natural Birth Is Always Best. You can imagine both my delight and my reaction…

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