the business of being born
Before we went on vacation for a week with the kids, first I and then Steve and I watched The Business of Being Born. I have Netflix and it’s a movie that they allow you to stream through your computer instead of waiting for it to come in the mail, so I watched it alone on my laptop and cried throughout. The second time I got to focus more on the film and less on my feelings about it, but Steve got to cry through it.
When we were visiting my sister, she asked why we were choosing a midwife in a hospital instead of a doctor in a hospital, and my answer was a jumble of words I didn’t mean. It helped me see that I really didn’t know why, truly, especially after my first horrible experience with a midwife at 8 weeks. The movie helped me to better articulate why.
I can say poetically that midwives are usherers of birth, allowing it to happen on its own time, while doctors see birth as a medical procedure. But what does that mean?
I can say now that, no matter what horror stories we’ve heard, 98% of births are natural processes, no intervention necessary. 2% are high risk, and that’s scary and puts lots of people in the hospital to prepare for the worst.
But that’s where it gets tricky, because doctors are trained to intervene. In the documentary, doctors were interviewed and asked if they had seen a birth without intervention, and none of the panel had. The reason is because labor takes time. A common scenario, according to doctors: women enter the hospital in a normal labor, but then are given pitocin because the doctors feel the labor’s taking too long — this is a business, these beds are real estate, the doctor’s time is money — and the pitocin increases the pain of the contractions, so they’re given an epidural, which numbs the pain and slows the labor process, so they’re given more pitocin, until the baby is in distress and the mother can’t feel it and so they declare an emeregency c-section, and everyone can say thank goodness for modern medicine, your baby could have died.
That is not a scenario I want. There is a rise in c-sections each day in a hospital at 4pm and 10pm: when the doctor wants to go home for dinner, and when the doctor wants to go home to bed. No matter how subconscious it is to the doctor, who I’m sure cares about each patient, this is a business. I can say that with a midwife I am permitted and prepared to stay in the hospital for four days if that’s how long it takes. They know that a long labor does not in most cases mean a baby in distress — a long labor on pitocin is more likely to mean that, but I can say that with a midwife I will be respected for not wanting pitocin, for not wanting to rush contractions past how fast my body is saying they should occur. That involves trust in the intelligence of the body, and faith in the strength of the woman — treating the patient as active, not passive. A procedure is not being done to them, like everyone else in a hospital bed; rather, a process is happening inside of them that the midwife is there to witness, monitor, and encourage.
Passive vs. active. There is a difference in techniques. Doctors put the laboring woman in a passive position. She is on her back, her legs up, which is a nearly impossible position in which to push. The midwives encourage any position that works. The one that is most likely to work is the one where gravity works with you: on your hands and knees. They encourage you to move around, get in tubs, walk around, bounce on birthing balls, stand up, kneel down, lie down. That difference is simple, but in one the midwife has to move in all sorts of positions to help you, and in the other you don’t bother the doctor. Laboring on the back flattens the pelvic opening, which lengthens the time of labor, and when it’s time for the baby to emerge it means there’s a greater chance of an incision (an episiotomy) to widen the opening.
That I can understand technically. What I can’t understand is the science of hormones. When a woman gives birth naturally, after the birth she experiences a rush of oxytocin that bonds her with her infant. Studies show that when monkeys are deprived of oxytocin after the birthing process — which occurs when humans are given pitocin or an epidural — the monkeys abandon their young. That rush of hormones is what leads to love. Plenty of women who have c-sections love their children desperately, maniacally, passionately, and humans are not monkeys, but it says something about that moment after birth that is untouchable. This paragraph is too fast and mechanical for what I’m talking about. In the documentary, you see these women screaming in pain, and then their babies are born and the mothers are instantly laughing, they look like they’re on crack they’re so happy. That rush of hormones. These mothers are instantly bonded to a degree I can’t fathom. I want to know what that moment is like.
Midwives aren’t toothless old ladies without any training. They have more training than a nurse, and as much training in the birthing process and its complications as any ob/gyn. They are certified and knowledgeable, and they have all sorts of medications at hand and know how to use them if necessary. They know when there is an emergency, but they also know that emergencies are rare.
And unpoetically, there is the fact of medical law suits. It is almost up to 1 in 3 births in the U.S. that involve a c-section intervention. 1 in 3 — a 40% increase in less than a decade. Some women request them because they’re afraid, because the pain of birth is something they’ve been led to believe they can’t and shouldn’t take. But in most cases it’s the doctor’s decision because the baby is “in distress”. Babies are not naturally in 40% more distress than a decade ago. This is because of the drugs, and because of a misuse of the fetal heart monitor, which monitors the fluctuations in a baby’s heart, which can be scary for usually no reason, and possibly because of a change in the health care system. If a doctor didn’t intervene, there is the risk of a lawsuit. The documentary showed doctors saying this with all honesty: in the short term, the safest thing to do is to cut her open. Cut her open and no one will say he didn’t do everything he could. Plus they get lots of money for c-sections, and the bed is available for someone else in 4 minutes instead of 4 days. That sounds horrible to say out loud, once again, but it’s the truth that more than ever this is a business.
This would all be fluff if the U.S. were saving babies’ lives. Who cares about the woman’s dream for her day of labor if it means that her baby dies. But this isn’t the case. The documentary cites these statistics: The U.S. has one of the highest maternity death rates in the world. The U.S. has the second-worst death rate for newborns in the world. As our use of medical intervention is climbing, so are our death rates. What we’re doing isn’t working. In all of Europe and Japan, where their maternity and newborn death rates are wonderfully low, midwives deliver 70% of all babies; in the U.S., midwives deliver 8%.
I know of too many high-risk pregnancies to say that they don’t happen, and I am not brave or trusting enough to have my baby at home. I want a hospital in case anything goes wrong, because I know they sometimes do. But I don’t want someone who has never seen a natural birth to be the one encouraging me to have one. I don’t want a doctor who is trained and paid to intervene to encourage me to birth without intervention. In those moments of labor, if a doctor says I should have pitocin, half of me will want to say no, absolutely not, and the other half will be terrified that my baby could die, and that side would win. I don’t want to be in that position, at the mercy of an authority that has been proven to kill more babies and mothers than almost any other country in the world, developed and undeveloped.
I know that the birth process will feel too long to me, but I know that a midwife won’t make me feel that I’m taking too long. I know that it will feel like I’m dying, and I’ll be afraid that I am, and I know that a midwife will reassure me that I’m not dying. I know that I am strong enough to do it on my own, just as most of the world does, and a midwife will not blink when she says that she believes I can.
