For further information on hospital birth or natural birth, contact Melissa Maimann at Essential Birth Consulting.
Hospital birth … which woman does not want to give birth in hospital in these days? Ask any pregnant woman where she is planning to give birth, and you will find that 96%+ of them will answer, “hospital”.
Less than 3% women will plan to give birth in a birth centre, and approximately 1.5% to 2% will succeed. 0.2% women Australia-wide will birth at home.
Hospital has been the first choice for women who are planning to give birth. Women choose to have their babies in hospitals because they are afraid not to. They are scared that if something goes wrong and they are not in hospital, that their baby will die, or that they will be harmed. They think that having a baby is like undergoing a major medical event so that they feel safe to be close to modern technology and a skilled obstetrician. The more the obstetrician costs, they better they must be. The more equipment and technology available in the hospital, the better it must be.
They are equally scared that if they don’t have a hospital birth, then they or their babies would die. In short, women no longer trust their body to give birth, despite the fact that it has been shown throughout centuries that women’s bodies are perfectly suited to give birth.
Some people argue this point, saying that mortality rates have come down dramatically since we moved birth to hospitals. And yes, mortality has come down and birth has moved to hospital. But it is not a cause-and-effect relationship. In fact, when birth moved to hospitals, MORE women and babies died. They died of infection because doctors would work on cadavers and then attend women in birth. They did not know about infection control.
The mortality rate came down after sanitation improved. Another important change was the development of a transport system that saw food being delivered to people year-round – fruit especially. Improved education and literacy also made a big impact. This all combined to improve the health of women and babies. Later, when contraception became more widely available, women were able to space their children, and this too meant healthier women and babies.
It is very rare, that a woman asks herself whether labour and childbirth are really life threatening and dangerous. This is because all women today are being bombarded practically from childhood to womanhood by the message that childbirth is dangerous. The fact that media portray that childbirth is full of complications and that most women will need medical help to give birth helps to reinforce this myth. How many TV shows depict birth as being easy, safe, painless and non-technical? Very few. And many women poo-haa those scenes saying, “oh, she must have been lucky”. Luck has nothing to do with it. Preparation, choice of care provider and place of birth, and determination have everything to do with it.
For most women, labour and childbirth are normal events.
Labor And Childbirth Are Normal Events
Women who are healthy and have low risk pregnancies should be able to give birth naturally if they are given correct information and preparation on how to do so. I am not of the belief that women need any pain relief in a normal labour. And without the use of pain relief, the vast majority of women will birth without complication.
Most Childbirth Complications Are Iatrogenic
Complications and/or horrible birth experiences that some of these supposedly low risk women experience are not caused by their body’s inability to give birth, but are often caused by medical interventions introduced one after another, during the hospital birth.
It looks something like:
- have an induction because you’re a couple of days past your due date
- this involves giving you gel so your cervix softens
- when your cervix is soft, your waters will be broken
- you will then need a drip to start labour
- because you have a drip (which can stress the baby), you will need continuous monitoring of your baby’s heart rate – that’s that monitor that they strap to your belly. Or, the staff may screw an electrode into your baby’s head and you will have 1 less belt on your tummy
- the drip will be increased until you are in good strong labour
- hopefully this process does not stress your baby. But most likely, it will stress you.
- unable to access the bath or shower or move into positions that help your body to birth your baby, you will need pain relief.
- you start on the gas
- the contractions are too strong for the gas
- you accept a dose of pethidine or morphine
- that wears off.
- you accept an epidural
- you will be examined regularly to assess progress
- you are now in bed, immobilised.
- your baby cannot move effectively through your pelvis
- your baby, unable to descend through your pelvis aided by gravity, and pounded by strong contractions, may become distressed
- if you are not yet fully dilated, you will have a caesarean
- if you are fully dilated, you will have forceps or a vacuum. Maybe an episiotomy too. And stitches
- you have an injection to speed the delivery of the placenta. Your uterus may be tired from the strong syntocinon-induced contractions. You may have a post-partum haemorrhage.
That’s called the cascade of intervention. Google it. It makes for interesting reading!
It is clear that for the most part, it is the hospital or doctor that causes the unnecessary complication of what is supposedly to be a low risk labour. This is achieved by interfering with the course of normal pregnancy or labour every step of the way. One intervention simply leads to another. Sometimes, it even starts in pregnancy with an ultraound because the baby is too big ….
In the scenario described above, see if you can count how many interventions the woman had (answers at the bottom). Let me know if I’ve missed any!
Of course, medical technology can be a life saver for true emergency situations. And I wholeheartedly promote hospital birth for high-risk women. But, the majority of women are not in this category. According to WHO, 80% women have healthy pregnancies.
You may have heard the legal phrase, “innocent until proven guilty”. Unfortunately, this does not apply to pregnant and birthing women in the hospital system. They’re guilty (high risk) until proven innocent (low risk) …. and unfortunately, that’s not until after the labour is over. In obstetric terms, birth is only normal in retrospect. Whereas midwives will always look for normality.
It is therefore not surprising that with this kind of birthing philosophy, birth becomes a more and more of a medical event rather than a normal family event.
Fetal Monitoring
Aside from this kind of obvious interventions, there are other routines along with the ‘dos and don’ts’ within the hospital policies that can potentially cause complications. The routine use of fetal monitoring during hospital birth, for instance, may seem harmless. But it also means you’ll have to lie still for the duration of the monitoring. You may be able to assume other positions, but continual movement will not permit the monitoring to pick up the baby’s heart rate. Unless a “clip” – read – thin wire that’s screwed into the baby’s head – is used.
To make things worse, the trace obtained from this machine (CTG) is often misinterpreted. Studies have shown that if you show the same trace to several people, they’ll all give different interpretations. And if you show the same trace to the same person, a few times over, each time the person will give a different opinion regarding the welfare of the baby.
Indeed, it has been shown that the use of CTG is associated with a dramatic increase in caesareans, without providing an improvement in outcome, compared to the use of the doppler to monitor the baby’s heartbeat.
Hospiral Policies
Interestingly, a lot of hospital policies are not in place to make birth easier. You would think that hospitals would help you to have a more natural experience. Rather, they are designed for the sake of efficiency and legal protection. As an institution, hospitals are more interested in managing the patients, than accomodating every client’s whim. The welfare and feelings of the woman are often taken out of the equation in the policy-making process. As long as the woman and baby are alive at the end of the process, it doesn’t matter whether women and babies are suffering unnecessarily. Suffering is hard to measure legally, whereas outcomes such as low apgar scores and duration of labour, are easier to measure and account for.
When you birth in an institution, no matter how person-friendly it seems to be, at the end of the day, you are on a production line. It is very process-oriented. The midwives are usually expert at not having you feel that you are on that conveyor belt. But you are. You are a thing to be processed according to hospital policies, deviations from which will not be tolerated because it interferes with the smooth running and efficiency of the whole machine (institution). The faster you can be put through the conveyor belt, the better for the institution. They can then have more through-put (income). Or, they (or their share holders) can benefit from fewer expenses (staff time) related to a shorter stay in delivery suite.
Thank you, Doctor
Unfortunately, many women think it’s normal to suffer greatly during childbirth. It is also quite common that they continue to believe that their bodies are abnormal and cannot withstand childbirth. They feel forever grateful to the hospital and their doctor, the one who saved them from the misery of childbirth, or who saved their baby from death. Little that they know that the source of disaster can be from the hospital intervention, not because of their bodies.
Hospital Is Not A Good Place For Healthy Babies
Finally, hospitals may not also be a great place to greet your newborn into the world. Aside from the fact that a hospital is a place full of antibiotic-resistant germs, a lot of hospitals also do not treat the newborn as respectfully or as kindly as you want it to be. In addition, there is usually separation between mother and baby after birth. At least for some time – maybe the baby will be in the same room as you, but may be assessed on the resuscitaire (how many women ask that their baby be assessed in the bed or on the floor or in the bath / shower with them?)
Also, many babies are separated from you over night “to let you get some sleep”. This sounds like a good thing at the time, until you get home and do not know what to do with your baby in the wee hours of the morning.
To Sum Up – The Truth Of Hospital Birth
In short, if you are planning to have a natural birth in hospital, consider the following:
Hospitals are rampant with medical intervention which can increase the risk of complications. As a result, you are at higher risk of having an unnecessary cesarian section if you choose a hospital birth.
You are not in control of your birth. Instead, hospitals control the birth through policies.
Hospitals are full of policies (routines) that are neither evidence-based nor birth-friendly.
In hospital, birth is viewed as a medical, not a normal, event. The health care professionals at the hospital are trained in pathology of birth, not normal birth.
The hospital environment may be impersonal and less cozy. This may impact your birth experience.
It’s almost impossible to have an intimate birth at a hospital.
Hospital Birth – YES or NO
After pondering the above facts, I hope you can now make your own decision on where you want to have your natural birth.
You have to realise that if you choose hospital birth, you have to be ready with all the consequences. A lot of time, requesting or rejecting certain procedures can cause irritation and misunderstanding between patient and the hospital staff. This friction may create a hostile or awkward environment which can make you feel uncomfortable and hard to relax.
Is this the environment you would like to be for your labour and birth ?
What are the other options?
There is good news!! There are two other options.
1. If you are a healthy woman, having a normal pregnancy, birth your baby at home with a registered midwife.
2. If you prefer to birth in hospital, or if you need to birth in hospital because you have a high risk pregnancy, employ the services of a private midwife. She can provide your antenatal (pregnancy) and postnatal (after baby is born) care and birth with you in hospital.
If you birth in hospital, expecting a natural birth, and you do not have a private midwife with you, this is much the same as doing your supermarket shopping in Bunnings. Newsflash! Bunnings do not sell groceries. Do not be disappointed when you do not find groceries in Bunnings. Rather, do your research and make choices that are aligned to the sort of birth you want to have. If you desire a natural birth and you’re healthy, have a home birth or a private midwife for a hospital birth. You do not need anyone’s permission (hospital, doctor etc). No more than you need their permission to have a massage or eat chocolate mousse. Private midwifery is known to carry a high natural birth rate and deliver excellent clinical outcomes to women and babies. The World Health Organisation recognises midwives as primary care providers for healthy, low risk women because midwifery care is know to deliver the best outcomes for this large group of women. For high risk women who are birthing in hospital, private midwifery will see you experiencing the minimal amount of intervention necessary.
ANSWERS:
1 gel
2 waters broken artificially
3 syntocinon drip to start labour
4 syntocinon drip to keep labour going
5 continuous monitoring
6 immobility
7 lack of access to the required tolls to facilitate normal labour
8 gas
9 pethidine or morphine
10 epidural
11 labouring in bed, unaided by gravity
12 caesarean or forceps or vacuum
13 vaginal examinations
14 forced (directed pushing) – needed with an epidural
These are the direct interventions. But what about the indirect interventions?
15 birthing in an unfamiliar environment
16 birthing with strangers
17 lack or direct one-to-one midwifery support
18 lack of continuity of care (can be assumed since vew few women are able to access this option in Australia)
19 imposed time limits on labour
20 managed third stage
21 separation of mother and baby after birth: a baby who is born after an operative delivery (caesarean, forceps, vacuum) will be taken to the resuscitaire for assessment by a paediatrician
22 breastfeeding will be impacted
23 bonding will be impacted.
Have I missed any? Let me know.
So …… 23 interventions when you thought you were only signing up for one!
Melissa Maimann, Essential Birth Consulting 0400 418 448