Birth without an Agenda

I’ve been thinking a lot about birth lately. Not that I’m pregnant, but since leaving the attachment parenting movement, I’ve started questioning a lot of the decisions I made under the heading ‘libertarian natural parenting.’ You may be surprised how much the two overlap (or not so much, if you find yourself in the same group), but a lot of libertarians  practice alternative and natural medicines as an outgrowth of their mistrust in conventional (government-approved) medicines.

I decided I would use midwives for childbirth and well-woman care in college, after reading an essay in “Liberty for Women” by Wendy McElroy, which discussed the plot by OB-GYNs to marginalize midwives. I didn’t follow up on any of the sources, but it was enough to convince me. OBs were money grubbers and pushed midwives out in order to make their field more professional for men and so they could charge more. Unlike Europe, American midwives did not move into hospitals when their patients did. I decided I wanted natural births and I had two of them.

It’s embarrassing now to think about how radicalized I when I was pregnant with my first child. I thought it was ridiculous that breech babies had to be automatic c-sections. Indeed, I viewed a c-section as something I wanted to avoid at all costs. My son was born after 12 hours of normal labor with the cord wrapped around his neck, screaming his head off. He was blue, but he quickly pinked up.

When my daughter was born, I was less radical. Having experienced the pain of childbirth, I decided if my baby was anything other than headdown, I wouldn’t mind a c-section. I wanted to tear less, too. But I also was beginning to feel bits of doubt regarding the quality of care I was receiving. The certified nurse midwife who had delivered Alpha had retired, leaving two lay midwives, one of whom was working on getting her nursing degree to become a CNM. The difference between a CNM and a laymidwife is huge. CNMs have masters degrees in nursing and midwifery. Lay midwives in my sate have to be present at 10 births and there may be some other training required, but I’m not sure about that. In other words, it’s a world of difference as far as training and ability is concerned. During my appointments with the lay midwife, she would often leave and go do office work, leaving my prenatal care in the hands of an apprentice midwife, which made me rather uncomfortable. How would they be able to tell if anything unusual came up if the midwife with experience wasn’t even around during appointments?

Later in my pregnancy, I started bleeding a lot. It turned out to be mainly stress due to buying our house, my son being sick and me generally not getting enough rest and being on my feet too much. My sister urged me to call the midwives since it could be premature labor. Since she’s a nurse, I listened and called the midwife on call. She told me to wait a while and call her back if it didn’t stop. It didn’t stop, I called her back. She told me to wait some more and try to get some rest. But I was so worried something was seriously wrong I couldn’t rest. I don’t think she really wanted to come in on her day off, but eventually she agreed to meet at the birth center where she examined me, told me everything was fine and sent me home. Hearing this actually managed to make me relax to where I could get some rest and if I had heard it 3 hours sooner, it would have let me relax that much earlier. When I talked to the lay midwife about that at my next appointment, her only comment was “sounds like your uterus was unhappy and telling you to slowdown!”

The great thing I’ve learned about midwives is that they really trust the process. Since they accept that birth is a normal condition, they can be very calm and help calm the patient down when the when the patient thinks things are not normal. The bad things about midwives is that since they view births as normal, they can be rather slow in recognizing when situations stop being normal. In birth that can happen extremely fast. In those situations, the more information you have, the quicker and easier it is to figure out that something abnormal is happening and get the baby out of there before permanent damage or death occurs. This would be the main benefit of fetal monitoring during labor and other practices that the natural birth community dislikes. Fortunately for my family, my  births went smoothly. But since then I’ve learned that:

* Homebirths and birth center births have three times the mortality of hospital births

*the difference between CNMs and lay midwives

*why constant fetal monitoring is important

* much of the information from the Business of Being Born is factually incorrect

* the only difference between a natural birth and having an epidural is the amount of pain you feel.

You can disagree with these points, there’s nothing wrong about that. But now, having looked at both sides of the issue, I’m beginning to think that the non-natural birth—should I call it mainstream birth?–side has more evidence. NCBers tend to rely on feelings and blow things out of proportion that don’t really matter. Take of example the ‘fact’ that vaginal births are better than c-sections because they expose babies to vaginal flora which helps the baby’s gut. If it really mattered, couldn’t c-sectioned babies just get a swab of their mothers’ vaginal flora in their mouths? It’s not like it’s hard to do. But that’s not the point. Their main goal is to encourage women to give birth vaginally and they are willing to distort data if need be.

Interestingly enough I came across a site called “sisters in chains,” which is all about midwives who are being persecuted for helping women give birth the way they want to give birth. They support letting women have control of their bodies and choose for themselves how they want to be handled and make decisions for themselves and birth how they want to birth. I also support these things. However, birth is one of those situations where you experience asymmetrical information. Just like when you take your car to the mechanics and have no idea if what the mechanic says is wrong with your care is actually wrong with your car or if he’s just making things up to get more money, you have no idea if your care provider is actually telling you accurate information in regards to your birth or pregnancy. In the end, it all comes down to trust. Women, especially women in labor, have to trust that their care providers have their best interests at heart. That they are not working for some larger objective, but specifically to provide the best outcomes for that woman and that baby.

But this is not the case with many midwives. Many of them say that their main objective is to empower women to birth the way they choose, but what if the way I choose isn’t the way they think I should choose? I’ve had two natural births. I’ve been there, done that. What if the next time I give birth, I want to have an epidural? What if I want to experience the other side? People who have had both natural and drugged births have said that the only difference between them was that the latter was painless.

Will women’s advocates support me in this decision? My guess is no, because their vision is one where every woman gives birth naturally, a world in which women are united by the pain of childbirth.