Many families having their first baby approach pregnancy with a mixture of wonder, joy and fear. They have, undoubtably heard many horrifying birth stories and seen birth depicted as frightening and life threatening in movies and books. As midwives specializing in community birth, formally known as out-of-hospital birth, we try and normalize pregnancy and birth and work hard to help families approach their upcoming birth in an excited and joyous state of mind. We often talk about pain as a rite of passage, referencing all cultures who use pain in some way to mark a transition from youth to adult. We say labor turns you into a parent, a new person rising from the the pain and blood, strengthened by fire, and ready to take on the task of raising a child. We talk about the amazing sense of self-confidence one has after a labor, the feeling that, after an unmedicated labor, you can do anything life throws at you.
There is a prevailing thought that we hear repeated, “It is my first baby and I think I should have a hospital birth”. While this is true for women experiencing a complicated pregnancy, many low risk, first time parents will do better with a midwife, giving birth outside a hospital.
Today, many hospitals have worked hard to make their rooms look and feel more “homey”. However, as the above picture shows, much of what happens during labor is, for the majority of women, not up for debate.
According to renowned anthropologist and childbirth educator Shelia Kitzinger;
“Women in our post-industrial culture are effectively captive in childbirth. The zoo may be run on scientific principles, the keepers may be considerate and may pride themselves on the good condition of their animals and the low mortality rate. Visiting times may be frequent and the zoo may be a friendly, welcoming place. In the confines of the cage there may be space to move about, and those in charge may have tried to replicate the natural habitat. Yet captivity restrains and dictates the behavior of the captives.”
Many midwifery consumers know that midwives practice something called “Evidence Based Medicine”. The Definition of Evidence-Based Medicine. Evidence based medicine (EBM) was originally defined as “The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients."
There are many research sites dedicated to investigating all interventions in childbirth to see if the intervention helps or, as was the case for routine episiotomies, hurts the women who are receiving the intervention. They have found that many of the routine interventions, from continuous fetal monitoring to restricting food and drink during labor, do not meet the criteria for helpful, i.e. reducing fetal morbidity and mortality. Yet, they persist. These same research groups have studied out of hospital birth over the years and the results have been consistent; there was no evidence that planned out of hospital birth, or community birthing, with a well trained attendant resulted in an increased risk of severe adverse maternal outcome.
First time mothers are at a distinct disadvantage when giving birth in a hospital. Using protocols set in place by many practices, they are more likely to be induced before their bodies are ready for labor, and more likely to have their labors augmented, given strong medication to increase the strength and duration of contractions. For women planning a natural birth, these interventions often lead to accepting pain medication to handle the mechanical (as opposed to spontaneous) contractions. These three things, induction, augmentation and pain medication are directly correlate to an increased risk of delivery by cesarean section. From research, we know the rate of cesarean section for a first time parent having an induction of labor approaches 50%!
As a midwife for many years, I have been guided by two principles: “Trust But Verify” meaning, while we believe pregnancy and birth are normal human functions, we want to do everything in our power, using the tools available to us, to “verify” that our parents and babies are healthy and “It Isn’t High Risk Until It Happens” meaning women can be at risk for certain conditions based on different factors, but we judge that woman to be low risk until proven otherwise. In our practice, we schedule an hour for each and every prenatal visit so that we can “Trust But Verify” and make sure it is “Not High Risk Until It Happens”! We also hope to establish a solid foundation build on trust and intimacy for the great work ahead.
Finally, for most community birth midwives, the concept of caring for the whole person, the whole family, allows us to incorporate the psychological and spiritual aspect of birth in our care. It is a wonderful thing to attend a birth with several generations of a family members present. There is singing and drums and prayer at our births. That, to me, is the beauty of community birthing. Great stories arise from powerful births and they need to be told. It is these stories that can begin a cultural change from fear to power, from passive bystander to active participant. Explore the possibilities to change the world one birth at a time!
Cynthia Jaffe has been a Licensed Midwife on Whidbey Island for 29 years and continues to catch babies. She and her partner Diana Miller, LM, CPM own The Greenbank Birth Center and welcome all families to come and see what all the fuss is about!