The Skeptical Hippy

Just Look Under Your Ass —Or— Thoughts On Hospital Birthing Practices June 17, 2012

It’s under yer butt.

Humans don’t like spending energy (physical and/or mental) on tasks that are considered unnecessary.  How many times do we look for keys, rush for an appointment or just get up from the comfy couch to change the channel because the remote cannot be located, only to realize that the energy used for those tasks was spent in vein?  The keys were in our pocket, the appointment is next week, the remote was under our ass.  How do we feel when we realize that the frustration could have been avoided?  Sometimes we’re slightly annoyed, sometimes the time spent on the activity actually had negative consequences, but often we are simply relieved that the chore is done, extra energy spent or not.

Imagine that the extra work/energy spent went into getting poked, prodded and then cut open.  After those events, you don’t feel relieved, you feel robbed of your time, energy, expectations and oftentimes, dignity.  But you are told to be grateful because at least you are alive.  You try to be grateful but can’t help feeling like something was taken from you.  It’s later that you learn those events may have gone differently if only you had the information to realize that the remote was just under your ass.  You were cut open, scared, scarred but how dare you feel angry and a little betrayed.  All the while listening to people complain that their time was wasted spending unnecessary energy on tasks due to a lack of knowledge: “I spent 30 minutes looking for her coat!  I was late to that appointment.  Ugh, the coat was in the damn car!”  You hear that they are angry and some still complain about their inconveniences days later.  However, you mention how your C-Section left you feeling traumatized and you are simply patted on the head, told “But you’re FINE and you have a beautiful healthy baby!” and they grumble behind your back, stunned at how ungrateful you are.

The knowledge that the remote was simply under our asses wasn’t always lost on us.  In Jacqueline Wolf’s book, “Deliver Me From Pain: Anesthesia and Birth in America”[1], she tells of a time before doctors were considered the star of the birthing show.  Women were intimately involved with not only their own child’s birth, but the birth of their family’s and friend’s children.  The laboring woman was surrounded by other women who had accumulated hundreds of years worth of knowledge through their mothers and their mother’s mothers.  It was considered common knowledge that if you were hungry, you ate (although I’m sure there were cautions as to not eat too much), thirsty, you drank and if you want to walk around, you walked!  Very few women labored on their backs for the simple reason that it didn’t feel good and the women around you would tell you that it’s not the best way to deal with the pain.  Women gave birth standing, squatting, on their hands and knees, on their sides, however nature seemed to guide them.  The pains of labor were taken care of by massage, breathing, meditation and the calming reassurances of women who had done this before.  Screams, grunts and silence were all to be expected.  The woman was the center of the show.  This was HER event.  She gave birth, someone else didn’t deliver her child.

For a variety of reasons the communal experience of giving birth gave way to (male) doctors being involved; ignorant male doctors.  This isn’t some feminist dig on men.  Men were not involved in the birthing experience.  Men didn’t know that the primal grunts and screams emanating loudly (and in their view, disturbingly) from their wives as their children entered the world, were more or less the result of nature giving us a vocal outlet for our efforts.  If you were to ask most women at the time “What was the most painful part of labor and childbirth?”  they would answer, “Transition” not, “Delivery”.  However, the doctors didn’t ask this question, they just assumed that these women needed pain relief as the child was crowning.  So women slowly became ignorant of the birthing process as doctors became more involved, shoving ether soaked rags in their faces past the time they would have wanted pain relief, the ignorant women grateful that the doctors must have saved them from most painful process of labor and delivery.  These women sang the praises of their benevolent doctors, encouraging others to do the same.  And hence, the beginnings of losing the knowledge that the remote was just under our asses.

Now, the tides of ignorance started to come in as early as the mid 1800’s.  Surrounded by knowledgeable women or not, birth at that time was dangerous.  Babies got stuck in the birth canal, women bleed to death, immature babies didn’t have much of a chance.  Hospital birth became the norm around the ‘30’s.  Maternal mortality and morbidity dropped during this time (thanks to the use of forceps and antibiotics and other medical advances that I am forgetting) but infant mortality and morbidity took an upswing.  Women at the time were pumped full of drugs, most of which were used to counter-act each other.  The effects the drugs had on the infants weren’t lost on the doctors but the systematic process of documenting those effects were not used until much later.

By the time it was realized that powerful depressants used during labor should be nixed (and therefore decreasing infant mortality and morbidity), over 90% of women were delivering in hospitals and the many practices that came along with hospital-birthing were well established.  Women were ignorant of the birthing process and were fully dependent on doctors, whose accumulated knowledge was more or less based on incorrect assumptions.  Obstetrics had become a well respected field of medicine and it was those doctors, not the women, who most definitely “knew better”.

Even during the ‘70’s when women were foregoing pain medicine and encouraging others to do the same, they were foregoing the analgesics in a hospital.  The hospital was still the default place to give birth and it continues to be now.  The infant mortality rate in the United State was 6.9 per 1000 births from 2003-2005[2].  It could be better in this country and there are various reasons why it’s not but overall it’s pretty good and women feel secure giving birth in a hospital.

So, why do women chose to birth at home?  There are various reasons but I reckon many make the decision by realizing that the remote is just under their ass.  All the procedures that have evolved over the years that are common in most hospitals are not based on quality scientific evidence.  To paraphrase my doctor “One of the first things I learned in medical school about obstetrics was that most of what is done isn’t based on good science.”  Being strapped down to the bed to counter-act the effects of twilight sleep, turned into being told by various nurses to “lay down” and not move during labor.  Yanking listless infants from their unconscious mothers’ turned into the default, push-on-your-back, position to deliver.  Cutting a woman’s perineum either because doctors at the time felt that pushing destroyed the “pelvic floor” or they needed the room for forceps, became the norm even after the myths of pelvic floor destruction were dispelled and forceps use went down (only recently have doctors stopped the “standard“ episiotomy).   Being too numbed up to feel the natural urge to push turned into “keep your chin down and push until you can’t any more” purple pushing.  Vaginal exams and continuous electronic fetal monitoring continue to be the tea leaves of nurses and doctors.  Women were given IVs to deliver pain medication, depressants and various other drugs are now given just to be sure that women are hydrated (and it’s considered necessary, which I don’t dispute, when given an epidural).

When one realizes that many of the uncomfortable procedures during labor could have been avoided and perhaps some of those procedures lead to unnecessary surgery, one tries to avoid those procedures in the future.  For some women that means avoiding the hospital all together.  For low risk pregnancies, the data seem to suggest that this is a safe option for most women.  However, despite the evidence against many common procedures and the evidence that is neutral on the safety of homebirth, it would seem that the obstetrical community misses the point entirely when homebirth is discussed.  They don’t focus on why women are choosing homebirth, simply that they are choosing it.  They scratch their heads and admonish, happy to tell tales of shoulder dystocia and uncontrolled bleeding.  Tales of triumph, the obstetrician coming in like a shining knight on a white horse.  “Why?” they ask.  “Why wouldn’t you want ME??”

The seeming refusal of the OB community to look in the mirror is frustrating for women who have realized that the remote is under their asses.  Hospitals that respect a woman‘s right to forgo those procedures are in the minority.  Tales of respected birth plans are few and far between.  My doctor is seen as enlightened to many women simply because she won’t perform vaginal exams unless she sees an indication for them and she “allowed” me to birth on my hands and knees.  I feel very comfortable in a hospital and much of that is due to the fact that my wishes to have my body do what it does are respected.  I also want the security I feel the hospital can provide by way of technology in case something goes wrong.  But many women feel (justified or not) that the facilities available to them will put them through those unnecessary procedures and often at the expense of their dignity and once in a while, their health.

If the obstetric community would find the remote under their ass, more women would willingly and quite comfortably chose to birth at hospitals.  Women who would chose to birth at home would do so not to avoid trauma but simply because that is what she wants.  Her decision would truly be a choice.

[1] – There are many facts stated in this piece.  Most of them are from this book and recited by memory.  If I had the book, my facts would be properly cited.  Oh, and BUY THIS BOOK!!  It’s now available for Kindle!  If you’re tight on cash, order it from your local library and if they don’t have it, suggest that they get it.  Many libraries will work with other libraries to get a book that you want.

[2] – Wiki baby! http://en.wikipedia.org/wiki/Infant_mortality