Birth is NOT normal - Page 2

[salr]

I think the OP just came here to vent feelings.  Her friend said to her that birth is not natural.  Yeah, OP.  I feel ya.  That seems like a weird statement to me.  

As to the pain aspect, her friend says that birth is "SOOO painful" but this friend has not given birth.  It's not like we can all say- don't dismiss this friend's personal experience.  I never want to dismiss the experience a woman has with her own body and birth.  But it does make me sad that this friend, and it seems a lot of people, discount the possibility that birth might NOT be painful.  A PP talks about relieving the "suffering" of birth.  I had an awesome time with my unmedicated birth.  No suffering involved.  Not getting an epidural doesn't automatically mean pain and suffering.  The sad thing to me is that people don't recognize that. 

I'm totally cool with women planning whatever kind of birth they want, but it might make me also feel that they don't know the full range of possibilities if they just assume that birth is automatically the most horrific thing a woman can go through. 

So OP, the "mental check" you got is probably a good thing for your friendship but I think I understand what you're feeling.
 

[artekah]

Originally Posted by Poogles0213 

Why is choosing not to feel pain the same as failing to see strength in one's body, though? My agonizing menstrual cramps are all natural, but I choose not to writhe in pain - I use painkillers. Does this mean I do not see the strength in my body? What's the difference?

Why assume that women who choose an epidural "don't have faith in their bodies" or "are so paralyzed" by fear, though? Maybe they just choose not to feel pain during this process - what's wrong with that?

How do you define "good outcome"? I define it as "healthy baby, healthy mom" - in that order. How does an epidural decrease safety?

Also, when an epidural should be used should be up to the individual woman - it is not up to you or anyone else to decide if the woman in now in the land of "last resort" and "needs" an epi. It is pain relief. Pain relief should be available to patients experiencing pain as they feel it is needed. Period.

Do you realize how insulting you sound when you imply that anyone who has used an epi (or other interventions) has missed "out on the true experience and all of the real feelings" of their child's birth?!

What "light at the end of the tunnel"? What if she doesn't believe there is any merit to natural birth, for her? She's obviously been exposed to it, knows it's a viable option, and then rejected it. Why must her choice be subjected to all these assumptions that she just must not be strong enough, informed enough, courageous enough, or is too conditioned by societal norms??

Whoa boy. Okay. You ask what is the difference between using pain meds for menstrual cramps vs. for giving birth. The difference is you *need* to be able to feel your body to effectively give birth. That's why *even* when a woman has an epidural during labor, they need to either let it wear off or turn it down somewhat before she can feel enough to push the baby out. Being able to move freely, choose the movements and positions that feel "right," and use gravity to help, usually helps a woman have a quicker and more straightforward labor and birth. Being flat on your back, regardless of how much or little pain you feel, is pretty much the worst position to be in when your body is trying to get that baby to move down and out.

You define "good outcome" as "healthy baby, healthy mom." Of course I agree with that. And epidurals (statistically speaking) decrease the chances of both. Not speaking for anyone else here. But for myself, a good outcome means not just healthy but also happy. An excellent bonding experience after birth, nobody getting between me and my baby, a great start to breastfeeding, my baby being treated gently at all times, sharing those transformative moments with people of my choosing, in an environment of my choosing. Not dealing with the effects or after-effects of drugs (for myself or my baby.) Being able to look back on the experience and feel elated at what I accomplished all on my own. Come to think of it, all those happy things I described also count as "healthy." It seems a lot of people define "healthy" just to mean "alive, and even if suffering in the moment, going to recover eventually." Clearly a good birth experience is not as important, or important at all, to many women. I honestly cannot fathom why, but that doesn't mean I don't respect them. I do, really. Again, I am speaking for myself, not others. Just trying to explain my reasoning.

I know I'm probably not communicating as well as I could. I certainly did not mean to come across insulting--as I said, it's a difficult thing to put into words because people (clearly) get very easily offended. But yes, I absolutely believe that *not being able to feel large parts of my body* would mean a *gigantic* loss of experience while giving birth--to me that is just "duh." Obviously *you* don't feel the same way, and that's okay with me. But isn't it okay if I don't *get* that? Being in a medical setting at all, for me, with other people doing things to me, yeah, I would be focused on dealing with all of that rather than focused on working with my body to make things happen. Not being able to *feel* my body? I can't imagine! Yes, it is important to me to *feel* my baby coming into the world, through my body, both physically and spiritually. I would choose an epidural if I felt I had to in order to get the baby born, but yes, it would be a loss of experience.

I know that people who have experienced both (all natural vs. medicated) are the only ones who can truly compare, and I know I have only seen one side of this personally. So I don't mean to be insulting. What I experienced (twice!) was just so sublimely awesome that I hate the thought of anyone missing out on that if there's any possibility they could've had it. It's the same reason that religious evangelists come across as obnoxious and insulting a lot of the time. They have seen God and they want you to experience what they "know." LOL By my intention is not to insult or diminish anyone.

Yes, how we give birth comes with choices, and those choices should belong to to woman herself and be treated with respect. Nobody should tell her what the best choice for her is, it's true. I totally agree with you there. But here's the thing. Women in this culture *are* undermined and *are* trained to fear birth, to maximize the fear of childbirth pains and to minimize their healthy distrust of anyone messing with their bodies in invasive ways, at least when it comes to giving birth. The HUGE majority of women in our culture don't study pregnancy and birth. Most women in our culture have never seen a natural birth, many may not even know anyone who's had one. Most are ignorant about the natural process and how interventions can impede it. The huge majority *do* just assume their doctors know best, even when the majority of doctors do not practice evidence-based care. So when you are making an uninformed choice, how much of a choice is it really? Would you make a different choice if you really knew all the facts?

If someone decides the benefits of an epidural outweigh the risks for her, that's great. She knows what she wants, more power to her. When someone isn't aware that there even *are* risks, and the "benefits" are blown out of proportion in her mind, that is not an educated choice. Seeing friends you love make uneducated choices that may mess things up for them, well, it's hard. That doesn't mean you can't support them and respect them. It doesn't even mean they aren't making the best choice for *themselves.* It's just hard.

This info can be found in Chapter 8 of Henci Goer's Thinking Woman's Guide to a Better Birth:

Epidurals slow labor, which results in increased use of Pitocin, and usually results in higher rates of episiotomy, forceps and vacuum extraction, and c-sections, especially in first-time mothers. Epidurals require electronic fetal monitoring and a precautionary IV. You are more likely to need bladder catheterization and more likely to develop a fever.

Electronic fetal monitoring increases the odds of a c-section. IVs, especially when given in large amounts over a short time, as they are when administering an epidural, can cause fluid overload, which leads to fluid in mother's and baby's lungs, maternal anemia, and blood chemistry disturbances in mother and baby. Bladder catheterizations can cause UTIs.

Oxytocin can lead to overly forceful contractions and fetal distress. Forceps and episiotomy increase the probability of anal tears, which can have long-term effects on sexual satisfaction and fecal incontinence.

C-section has both short and long-term risks. Maternal fever may stress the baby during labor. And because fever may signal uterine infection, the baby is more likely to be separated from you after birth for observation and subjected to blood tests, a spinal tap, etc. Some data suggest that epidurals increase the probability of actual infection in the baby.

The procedure itself, apart from the drugs involved, can cause problems. An epinephrine test dose can cause fetal distress. Using air to locate the epidural space can cause neurological and other complications. The catheter can injure blood vessels and irritate nerves.

Potential postpartum complications include temporary urinary incontinence, nerve injury, a blood-filled swelling, and an excruciating, incapacitating headache which can last for days (spinal headache.) In the newborn, epidurals may cause adverse physical and behavioral effects.

I don't want to type out the whole book, but it goes on to describe potentially life-threatening complications as well (life-threatening to both mother and baby) including a dangerous drop in blood pressure, drop in baby's heart rate, convulsions, respiratory paralysis, cardiac arrest. Respiratory paralysis and cardiac arrest occur as commonly as 1 in 3,000. To give you some perspective, drugs causing serious adverse reactions in this range have been withdrawn from the market or forced into restricted use.

It goes on to describe adverse physchological effects of having a medicalized birth.

Recent innovations in technique have not reduced the incidence of problems.

I personally can't understand why someone would take that amount of risk to themselves and their child if they didn't *have* to. I admit that I usually conclude that the person is unaware of the risks--because it just seems so illogical to me. Maybe I am missing something. I do understand why so many women have such an irrationally high fear of birth, as pregnant/birthing women in our culture are not seen as the badasses they are. They are pathologized, infantilized, disrespected and acted *upon* when really they are the ones who should be in charge. It seems most people don't question the flaws of their culture and are more willing to see flaws in themselves.

Again, I don't have to *understand* what someone is thinking/feeling to be able to still *respect* them. And I will continue to agree with all of you that it's the woman's choice and as her friend, you should be supportive of her.

But that does not mean I have to be supportive of practices that harm and disempower people, and it does not obligate me to just shut up, when I think I have information that may help others.

[Buzzbuzz]

As a mother who has homebirthed and most recently had (by choice) a hospital birth with an epidural, I noticed that many of my friends who were more invested in natural childbirth really struggled with my choices as the OP seems to be doing.

Basically, what I observed was that it was very threatening for some of them that I had effective pain relief and a healthy, wonderfully bonded baby that breastfed beautifully -- simply because it made them question the value of the pain they themselves had experienced having natural childbirth.  Somehow, my birth choice became a judgment on their birth choice, if you know what I mean.  So given the minefield that this sort of thing became for me, I would suggest that the OP tread with caution with her friend and make sure she is not coming coming from a place of self defense but rather true support.

[StudyingStones]

Originally Posted by Poogles0213 

Why is choosing not to feel pain the same as failing to see strength in one's body, though? My agonizing menstrual cramps are all natural, but I choose not to writhe in pain - I use painkillers. Does this mean I do not see the strength in my body? What's the difference?

Why assume that women who choose an epidural "don't have faith in their bodies" or "are so paralyzed" by fear, though? Maybe they just choose not to feel pain during this process - what's wrong with that?

How do you define "good outcome"? I define it as "healthy baby, healthy mom" - in that order. How does an epidural decrease safety?

Also, when an epidural should be used should be up to the individual woman - it is not up to you or anyone else to decide if the woman in now in the land of "last resort" and "needs" an epi. It is pain relief. Pain relief should be available to patients experiencing pain as they feel it is needed. Period.

Do you realize how insulting you sound when you imply that anyone who has used an epi (or other interventions) has missed "out on the true experience and all of the real feelings" of their child's birth?!

What "light at the end of the tunnel"? What if she doesn't believe there is any merit to natural birth, for her? She's obviously been exposed to it, knows it's a viable option, and then rejected it. Why must her choice be subjected to all these assumptions that she just must not be strong enough, informed enough, courageous enough, or is too conditioned by societal norms??

Poogles, I was speaking from personal experience only. I had an epidural because I was terrified of the pain, and I didn't know whether or not I could push a baby out. My mom had two labors and two c-sections due to failure to progress.. she just didn't dilate for either my brother or myself, despite 24+ hours of labor.   I was never trying to be insulting, just putting it out there that I'm sure there are other women in the world that share the fears that I had.

[CI Mama]

Full disclosure, for those of you who don't know me, I'm one of the women who gave my all to a natural birth and ended up with a 33-hour labor and a c-section, for reasons that are unfathomably complex. So threads like this tend to be a bit of a trigger for me. However, I will risk putting in an answer.

I really hate the phrase "birth is normal." Normal is just such a bland, everyday, middle of the road, average sort of word. Pregnancy and birth for me were NOT normal. They shook me to my foundations. They transported me so far out of "normal" reality that it has taken me years to find my way back. I guess for some women, birth is "normal"...that is, it just happens without a major reorganization of one's self, like a million other normal things that we do in life. That's great for those women, but I'm not one of them, and I can't relate to that sentiment.

I didn't have perfect confidence in my body, and it wasn't clear to me that a "natural" birth was something I should automatically expect. It wasn't just about my fear of pain, it was about a thousand other things...my own birth and adoption, my relationship with my mother who died of ovarian cancer, my history as a dancer, my long journey with infertility, my deeply complex feelings about becoming a  mother, my lesbian identity...to name just a few. In spite of this complexity, I decided to give my all to a natural birth. I was pretty well informed. I wasn't able to make a perfect set of choices, but I did the best that I could. I am one of those for whom the best wasn't good enough. I made the wrong gamble. I probably would have benefitted from more interventions earlier in my labor. I might have avoided my c-section that way. I might have at least avoided some of the suffering that came with having a grueling long labor before my surgery.

There is no question that part of my "going for" a natural birth was my conviction that to do otherwise would be uninformed and cowardly. I very much wish that I had gone into labor with a less rigid standard for myself. It has been a tough and valuable spiritual lesson to be compassionate with myself for what I did not and could not know about birth before I went into it.

For some women, trust in your body means turning away from medical interventions and letting your body find it's way alone. For other women, trusting your body is knowing yourself and your history well enough to know that you need to ask for help and having the courage to ask for it. To assume, based on a brief remark that a woman says, that we can know what her relationship to birth and its complexities is, seems very presumptuous to me. Can we really know where another woman's strength lies, where her wisdom resides, what will shake her to the core, and what is "normal" for her? Can we even know it for ourselves?

I prefer the phrase, "birth is a mystery." Each of us has to decide for ourselves how we want to approach that mystery.

[artekah]

Originally Posted by CI Mama 

Full disclosure, for those of you who don't know me, I'm one of the women who gave my all to a natural birth and ended up with a 33-hour labor and a c-section, for reasons that are unfathomably complex. So threads like this tend to be a bit of a trigger for me. However, I will risk putting in an answer.

I really hate the phrase "birth is normal." Normal is just such a bland, everyday, middle of the road, average sort of word. Pregnancy and birth for me were NOT normal. They shook me to my foundations. They transported me so far out of "normal" reality that it has taken me years to find my way back. I guess for some women, birth is "normal"...that is, it just happens without a major reorganization of one's self, like a million other normal things that we do in life. That's great for those women, but I'm not one of them, and I can't relate to that sentiment.

I didn't have perfect confidence in my body, and it wasn't clear to me that a "natural" birth was something I should automatically expect. It wasn't just about my fear of pain, it was about a thousand other things...my own birth and adoption, my relationship with my mother who died of ovarian cancer, my history as a dancer, my long journey with infertility, my deeply complex feelings about becoming a  mother, my lesbian identity...to name just a few. In spite of this complexity, I decided to give my all to a natural birth. I was pretty well informed. I wasn't able to make a perfect set of choices, but I did the best that I could. I am one of those for whom the best wasn't good enough. I made the wrong gamble. I probably would have benefitted from more interventions earlier in my labor. I might have avoided my c-section that way. I might have at least avoided some of the suffering that came with having a grueling long labor before my surgery.

There is no question that part of my "going for" a natural birth was my conviction that to do otherwise would be uninformed and cowardly. I very much wish that I had gone into labor with a less rigid standard for myself. It has been a tough and valuable spiritual lesson to be compassionate with myself for what I did not and could not know about birth before I went into it.

For some women, trust in your body means turning away from medical interventions and letting your body find it's way alone. For other women, trusting your body is knowing yourself and your history well enough to know that you need to ask for help and having the courage to ask for it. To assume, based on a brief remark that a woman says, that we can know what her relationship to birth and its complexities is, seems very presumptuous to me. Can we really know where another woman's strength lies, where her wisdom resides, what will shake her to the core, and what is "normal" for her? Can we even know it for ourselves?

I prefer the phrase, "birth is a mystery." Each of us has to decide for ourselves how we want to approach that mystery.

I like this. Thanks.

[Alenushka]

The dangers of epidurals are overstated all the time.

Anecdata....I know many women whose bodies and babies were hurt during homebirth. I do not know a single one who was hurt by an epidural.

[artekah]

Originally Posted by Alenushka 

The dangers of epidurals are overstated all the time.

Anecdata....I know many women whose bodies and babies were hurt during homebirth. I do not know a single one who was hurt by an epidural.

Really? I have heard lots of women talking about spinal headaches and nerve damage and how something still physically bothers them years after.

And it's not the epidural itself that is the most scary thing (although even just the needle is admittedly slightly scary.) It's the cascade of interventions--which I KNOW does not always happen, but happens frequently enough to be serious--that terrifies me.

Also the fact that being forced to be lying down, immobile, strapped to machines, and monitored by other people--it is quite a stretch to say that is a psychologically empowering position to be in.

I suppose you surrender to the process when giving birth no matter what, and some people surrender to medicine and interventions while others surrender by trusting their own body. And in the end it's all the same.

But still I just can't wrap my mind around why someone would willingly choose the medicalized version unless she was forced, or very uninformed.

Alenushka, you seem as much invested in medicalized birth as I am in natural birth. If you have had great experiences with the medicalized version, then that is really wonderful and brings me hope that it can be that way for more women. I just have too many friends who've had *terrible* experiences--I mean like, horror stories, in the hospital with an epi, to believe that a positive empowering hospital experience is anything but an anomaly.

I witnessed one of my best friends birth in the hospital with an epidural, before I had my kids. It was such a shockingly horrible ordeal, took all her power away and hurt her so badly. I am still traumatized by the memory--I can only imagine how she feels. It was a major factor in choosing natural birth for myself later.

I know my friend is just one person. And yes, I know those positive stories exist, just like homebirth-gone-wrong stories exist.

I really do agree with the "birth is a mystery" sentiment.

[McGucks]

I am glad I had an epidural with both my children and have no regrets about my second child being born via c/s.

DS1:  I still have residual pain (almost 17 years later from my first epidural).  Just between the vertebra and not often, but it's there.

DS2:  Two and a half years after my c/s, my abdomen still feels weird and sometimes hurts.  I don't have the money to do acupuncture or massage for what I suspect are adhesions.

I kinda liked the dad's perspective with the analogy regarding the root canal.  No, a root canal is not "natural," but if a tooth was rotting, would anybody look down on Novocaine for an extraction? 

Bottom line for me is:  whatever works for you works.  I don't believe in gold medals for pain tolerance.  If you are okay with the path you chose, dandy.  That's really all that matters.

[Alenushka]

Why people always talk about cascade of interventions?

What about cascade of non interventions?

The effect of c-cestion not being done when it should have been done are father graver than c-section done when is should have not been.

Loss of perfect birth experience vs loss of the baby and maybe mother.

Birth is natural...so is cancer and kidney stones

[artekah]

Originally Posted by Alenushka 

Why people always talk about cascade of interventions?

What about cascade of non interventions?

The effect of c-cestion not being done when it should have been done are father graver than c-section done when is should have not been.

Loss of perfect birth experience vs loss of the baby and maybe mother.

Birth is natural...so is cancer and kidney stones

Oh geez, give me a break! Nobody (certainly not I!) is suggesting anyone choose not to get a c-section if they need one, or an epidural if they need one, for that matter. I'm pretty sure we can all agree that we are truly grateful the miracles of modern obstetrics are available to us.

Nobody is denying that things can go wrong in birth and that mothers and babies lives are saved by interventions.

I am not saying any of that, and I'd appreciate you not putting those words in my mouth.

People talk about the cascade of interventions because it is REAL. It is documented. It is not a figment of the imagination of a bunch of wackadoodle hippies. It actually does hurt people, and cause unnecessary pain and suffering.

In the U.S. the c-section rate is around 33%. The Farm Midwives c-section rate is 1.5%. Will you not admit there's something wrong with that picture??

What we are talking about here is a first-time-mom jumping straight into the interventions without even being aware of the possibility she might not need them, or that they might cause her harm.

Maybe that IS the right choice for HER. Sometimes it's the right choice. But when almost everybody in the population takes that approach, there is something wrong with the culture. That is a public health issue.

"Baby Friendly" hospitals are those whose practices support a good start to breastfeeding. At this time only 6% of U.S. hospitals are doing this! It's crazy.

That's what all the upset is about. Nobody wants to turn down needed medical care or deny it to anyone, or make anyone feel bad for needing it when they do. This is about wanting to make things better!

[artekah]

Originally Posted by McGucks 

No, a root canal is not "natural," but if a tooth was rotting, would anybody look down on Novocaine for an extraction?

Key words here: "IF a tooth is rotting!" Epidurals are great *when needed.* It's reasonable to assume you don't need an epidural, until you do. Not the other way around.

And epis should be approached with much more caution. As far as I know, Novocaine is unlikely to cause your root canal to go awry, causing you to lose other teeth for example, or risk possible life-long pain every time you chew. (Which can happen when an epi increases chances of an episiotomy, for example.)

Root canal--birth: not an accurate comparison. Epidural--Novocaine: not an accurate comparison.

BTW comparing birth to disease (cancer/kidney stones) is completely ridiculous. Birth is its own beast. It sometimes has complications and does not always go smoothly. But it does not equate to an injury, a disease, or a malfunction by its very nature.

McGucks, in case it needs to be said: I am not saying your birth interventions weren't needed, and I'm not making any judgement on you. I'm glad that you did what you needed to do and that you have no regrets.
Edited by artekah - 8/18/12 at 11:46am

[homeschoolingmama]

Thank you Sympathetic Dad.  I had two of my children with epidurals.  For my third I thought, hey I can do this.  I was induced and then went natural.  That is the most traumatic birth by far.  I was so out of it it was unbelievable.  I was scratching my face and flipping out.  I focused on a spot on the ceiling and did fine until closer to the end.  I kicked the doctor out of nowhere.  It was awful.  I cried and cried after that birth.  My next two I had epidurals.  My last one I got one right at the end so went through heavy birth like my 3rd for a while.  Not everyone feels the same way as you all.  My births with the epi's were beautiful!  I could feel them coming down, look at the expressions on people's faces and it was plain wonderful.  I love those births.  I hated my other two births.  I am not a wimp.  I didn't flinch getting a tattoo around my arm.  I know my body was made to do this but MY body does not do well.  

I finally realized that it is because of my SPD.  There is no info on this but I know this is what it is.  I have an extremely hard time nursing too.  The sensation is unbearable.  I literally rub my toes together so they are bleeding so I can concentrate on that pain instead of the nursing sensation.  All of my friends have home births and that is wonderful.  I have come to terms that not everyone thinks birth is beautiful if it is pain free and natural.  FOR ME, I have a different way of achieving beautiful.  Your BF has already been exposed to home birth and I am sure has heard all of its benefits.  I think this is a time for support and encouragement for HER birth plan.  It took me a lot of years to get out of the guilt of getting epi's when everyone around me wasn't and hopefully your friend won't feel that way.  Every birth can be beautiful whether they are born at home, at the hospital, with pain meds or not.   

[suchende]

Originally Posted by artekah 


Really? I have heard lots of women talking about spinal headaches and nerve damage and how something still physically bothers them years after.
And it's not the epidural itself that is the most scary thing (although even just the needle is admittedly slightly scary.) It's the cascade of interventions--which I KNOW does not always happen, but happens frequently enough to be serious--that terrifies me.
Also the fact that being forced to be lying down, immobile, strapped to machines, and monitored by other people--it is quite a stretch to say that is a psychologically empowering position to be in.
I suppose you surrender to the process when giving birth no matter what, and some people surrender to medicine and interventions while others surrender by trusting their own body. And in the end it's all the same.
But still I just can't wrap my mind around why someone would willingly choose the medicalized version unless she was forced, or very uninformed.
Alenushka, you seem as much invested in medicalized birth as I am in natural birth. If you have had great experiences with the medicalized version, then that is really wonderful and brings me hope that it can be that way for more women. I just have too many friends who've had *terrible* experiences--I mean like, horror stories, in the hospital with an epi, to believe that a positive empowering hospital experience is anything but an anomaly.
I witnessed one of my best friends birth in the hospital with an epidural, before I had my kids. It was such a shockingly horrible ordeal, took all her power away and hurt her so badly. I am still traumatized by the memory--I can only imagine how she feels. It was a major factor in choosing natural birth for myself later.
I know my friend is just one person. And yes, I know those positive stories exist, just like homebirth-gone-wrong stories exist.
I really do agree with the "birth is a mystery" sentiment.

Woah @ bolded. 

I am constantly amazed at how many people engaged in this particular discussion cannot see that it's an area where reasonable minds can differ. I personally am still on the fence, after reading extensively on both sides of the discussion (and having an educational and professional background that helps make me a relatively sophisticated consumer of scientific literature). 

Many women choose medicalized birth after a natural birth. Hard to think of a more informed decision maker than a S+TM, IMO. Other mommas do the opposite. I am wondering what information you think moms who have done both are missing, when they say they'd go medical again?

[SympatheticDad]

Originally Posted by artekah 

BTW comparing birth to disease (cancer/kidney stones) is completely ridiculous. Birth is its own beast. It sometimes has complications and does not always go smoothly. But it does not equate to an injury, a disease, or a malfunction by its very nature.

I have to disagree here with you on a few points.  This may make me a little unpopular.  I apologize in advance.

First off, in terms of the pain caused or not caused, it's perfectly valid to compare childbirth to other potentially painful procedures or trauma that can happen to a human body.  I'm aware that we all like to get misty-eyed about the incredible beauty of this miraculous event blah blah - I did it a little myself a few posts ago.  But if you step away from it and just look at what's happening physiologically, you're passing a huge object out of an opening that (in a primipara) has to stretch to a size it's never been before, and to make matters worse orient it in such a way that it passes through the MOST STUPIDLY-SHAPED HIPBONE IN THE NATURAL WORLD.  Childbirth is beautiful, yes.  It is also hugely traumatic, in the dictionary sense of the word.  If the analogy between childbirth and a root canal fails it is only because childbirth is more dangerous (according to several thousand years of human experience) and more painful (according to my wife).

Second, a few people on this thread have made reference to women's bodies being not just natural but 'designed'.  This is a misunderstanding of how evolution works.  Over hundreds of thousands of years (and probably tens of thousands of generations), evolution has blindly stumbled, through random mutation, on a geometry for human bodies that allows huge-headed babies to come out of the womb (barely) while still preserving the ability of women to run, upright, presumably to avoid being eaten by bears.  The only thing that this means is that more women with this body geometry managed to reproduce than women with other body geometries.  For all we know, there were mutations for women with much larger hip-bone interiors that gave birth more easily, and more successfully, but then who were devoured by bears moments after birth, or sometime thereafter.  The only thing that matters, evolutionarily, is that enough women were able to reproduce.  A huge number of women could (potentially) die during childbirth, and evolution would happily skate on, blissfully unaware, as long as those who lived could reproduce.  This is why whenever I see the word 'design' in these threads, my eye twitches.  According to the best studies I could find, the 'natural' maternal death rate is estimated at about 1500 per 100,000 births.  That's a death rate of over 1%.  That's a pretty lousy design.  If there was a 1.5% chance you'd die every time you got in a car, you'd never get in it.

Fortunately, thanks to modern medicine, the actual modern Western death rate is more like 9 in 100,000, according to the WHO.  In Sub-Saharan Africa, which is rich with folk-wisdom and midwives, but lacking in medical supplies, the death rate is 900 in 100,000.  Let me say that again in another way: when modern medicine isn't available to assist with childbirth, the death rate is two orders of magnitude higher.  So although we can all agree that "birth isn't a sickness!" I actually don't agree with the assessment that "birth isn't a medical event", because we have good statistics, gathered today, that tell us that without medical expertise - which doesn't necessarily mean provided by an O.B., mind you, Certified Nurse Midwives have great results in studies, for example -  it's a hugely risky medical event.

Lastly, I need to say something about the "cascade of unnecessary interventions".  The problem is that there is a fundamental misunderstanding, in this country at least, about what the job of a doctor is.  We all think (and I used to think this way too) that a doctor is a woman or man in a white lab coat who runs a lot of tests and then figures out what is wrong with you by looking through a microscope.  Maybe there's something completely new wrong with you - that's ok!  The doctor will figure it out!  Likewise, if you're pregnant, the doctor will look at you and just be able to tell "A-ha!  Your blood-pressure is X, and your skin tone is Y, this means that you are just beginning to go into pre-eclampsia! TO THE HOSPITALMOBILE, we will save you!"

I'm here to tell you that you are wrong about what doctors do.

What doctors know is statistics and how to use them.

With many syndromes in pregnancy, by the time there are obviously visible symptoms, it is often too late to save the baby; pre-eclampsia is a great example of this (disclaimer: i am not a doctor, and i don't actually know anything about pre-eclampsia.  I'm just using this as an example of the sort of analysis you'd prefer to do before there is an acute problem).  The analysis is statistical.  Does the patient have risk factors for pre-eclampsia?  Well, let's see.  Her mother had pre-eclampsia in a pregnancy.  This is her first pregnancy, and she's 18, obese, gets frequent migraines, and has gestational diabetes.  Based on the totality of those factors, this patient has X% of developing pre-eclampsia.

In walk two patients, Alice and Betty.  Alice and Betty, let's say, present with the exact same medical histories and yield the same statistical chance of developing pre-eclampsia.  Let's make it easy and say it's a 50% chance.  Either one (or neither) of Alice or Betty might get pre-eclampsia and lose their babies or their lives.  No doctor in the world can tell which one of them it will be.  All they can tell you is that, statistically, half of the patients with these symptoms end up in pre-eclampsia.  Thus, since 50% is a really, really huge chance when lives are on the line, the doctor will probably recommend extremely frequent examination coupled with early induction or c-section at the first wisp of trouble.

The thing about statistics and probability is that the statistics are only meaningful before the outcome is revealed.  This is super-hard for non-mathematicians to understand, but it's true.  If you flip a fair coin, you have a 50% chance of getting heads.  If you look at the coin, and it's tails, it's nonsensical to say "well, I might still get heads half the time I look at this coin."  Once you've looked at that coin, the chance of it being tails is 100%, and the chance of it being heads is 0%.  A proper statistical analysis is about future events.

The 'Unnecessary cascade of interventions" language is all about proving, after the fact, that the coin was tails so therefore the interventions were not needed.  But just because the coin happened to turn out to be tails does not mean that before we knew the outcome the 50% chance of it being heads didn't exist.  Analogized a different way: just because you arrived at your destination safely doesn't mean that there wasn't risk from being in the car with a drunk driver.  Yes, sometimes a doctor can look at an X-ray, and say "Welp, your arm is broken.  Let's put a cast on it."  But more often, particularly in pregnancy, all they can do is say "Other women with your presentation had this good outcome X% of the time, and this bad outcome Y% of the time.  My medical opinion is that we should do (some intervention) to try to avoid the bad outcome, because I think Y is a big number."

Anyway, I've gone far afield from the topic here.  But I just wanted to address some of these points because I see this language all the time, and I think it does everyone a disservice when we fail to remember that medicine is, by and large, about understanding and applying probability and statistics.  Mothers (and, more generally, patients) always have the right to make their own decisions about whether to accept or refuse treatment.  But I think it's important to do that from a position of knowledge, based on data and an understanding of probability and statistics, rather than a position of weakness, based on intuition and superstition.

Edited by SympatheticDad - 8/19/12 at 6:08am

[salr]

SympatheticDad,
 

What I am saying is that the experience of childbirth is not necessarily painful.  Your wife experienced pain, so do many other people.  I told myself that birth would either be so painful I wanted to die, be orgasmically wonderful, or somewhere in the middle of those two extremes.  I happened to have a labor that was a lot of hard work but was an overall amazing enjoyable experience.  Not because I was misty-eyed, but because I was working hard to do something important and I liked it and had interesting sensations. There were moments that hurt a bit but then I would just recognize that and try to relax more.  It worked for me. Everyone's experience is different. Please don't discount my experience and the possibility that a woman could be missing out on this type of experience if they choose a more medical birth. 

Maybe another woman would try to "go natural" and find it so bad that they needed pain relief or a c-section.  That's cool, they have that available to them here in the U.S. and that's great. I think it's also great that a woman can choose to do whatever she wants for birth, and that she can decide ahead of time or in labor.  Whatever works for her.  But to have a culture that only talks about how painful birth is, is missing a lot to the discussion.  

I believe birth isn't a medical event until some specific problem presents itself that makes it a medical event for that particular birth.  Until then, women are just doing the best they can to get the baby out of them.  And the body has a really impressive way of doing that.  It's not like a baby just squeezes itself out of a regular everyday uterus, cervix, and vagina.  Things happen in the body to get it all prepared to birth.  Penises change shapes and sizes every day, then go back to how they were. That seems pretty wild to me.

[GoBecGo]

I'm one of thos lucky people who have fast and manageable births.  Manageable as in hurts for maybe 20 seconds of a 60 second long contraction, fast as in 86 mins with #1. 61mins with #2.

I fully accept my births are so "abnormal" that there's no point in me telling other people anything other than "my story" - i can't say it doesn't hurt, only that it doesn't really hurt me.  I can't tell them it's not exhausting, only that it doesn't really exhaust me.

The thing that would really worry ME in your friend's plans is what will happen if....  I'm in the UK.  You're not going to get an epidural the second you want it.  Not unless you're pretty lucky, there's not that many anaesthetists and those there are are split between theatre and labour ward, so you really might have to wait for 1-4 hours for that epidural.  So for that reason i'd be encouraging her to think of how she'll cope if the epidural isn't immediately available.  In addition it only partially works for A LOT of women.  It doesn't work at all for very few but many have partial relief or windows of no relief, so a pain free birth isn't in any way guaranteed, even if she DOES get her epidural right away.

Birth, like the rest of life, is not perfect.  Contingency planning is only sensible.

[artekah]

Originally Posted by suchende 

Woah @ bolded. 

I am constantly amazed at how many people engaged in this particular discussion cannot see that it's an area where reasonable minds can differ. I personally am still on the fence, after reading extensively on both sides of the discussion (and having an educational and professional background that helps make me a relatively sophisticated consumer of scientific literature). 

Many women choose medicalized birth after a natural birth. Hard to think of a more informed decision maker than a S+TM, IMO. Other mommas do the opposite. I am wondering what information you think moms who have done both are missing, when they say they'd go medical again?

I'm sorry, you are right. I meant, and should have said, not just "someone," but specifically, a low-risk, first-time mom. I specifically had the OP's friend in mind when I said that, and did not mean to make a blanket statement. A low-risk first-time mom should give herself the greatest chance for the least amount of stress/danger/damage/etc. Moms who have done both (home/hospital, or whatever...) clearly have more insight into themselves and what their available options can offer them. Someone with no insight, when everything is a huge great unknown, should prepare for the worst but expect the best--meaning, have your "Plan A" be smooth sailing, simple, no interventions--because hey, chances are good it will go down that way, especially if you take measures to increase your chances, by carefully choosing your care providers and arming yourself with knowledge and confidence in yourself. With medical interventions only being used IF necessary, as "Plan B." That is what I was trying to say.

I understand that this is an area where reasonable minds can differ. I even acknowledge that for some low-risk first-time moms, the medical route is the best decision, because when it comes down to it, the best circumstances for a mother to birth in are often those where she feels safest. If those circumstances also open her up to additional risk, it *still* may be the best decision given all the factors.

What I am just wishing is that more women had the option to FEEL safe, and BE safe, at the same time. This won't happen until the majority of practicioners switch to an evidence-based midwifery model of care. And/or the majority of the population becomes more informed and demands better options.

[trimommy2009]

I've really loved reading all of the responses to this post, they have all given me new insights into looking at birth differently for different people.  I had two wildly different births, the first being an unnecessary c-section, the last one being a home birth almost 5 months ago that still has me on cloud nine and I've unfortunately fallen into the trap that my birth is best.  Reading these replies has helped me learn how to be a better friend and support her decisions regardless of what they might be.  I may still spout some solid research studies when she asks my opinion though (just recently she asked about induction at 40 weeks and I sent her some info on bishops scores), but only if she asks. I think a lot of times doctors still leave out the "informed" in informed consent. 

That being said, I will forever feel birth is a natural and normal experience that should not be treated as a medical event in MOST situations and I will continue to speak openly about the joys of natural childbirth that I myself experienced. 

[artekah]

Originally Posted by SympatheticDad 

I have to disagree here with you on a few points.  This may make me a little unpopular.  I apologize in advance.

First off, in terms of the pain caused or not caused, it's perfectly valid to compare childbirth to other potentially painful procedures or trauma that can happen to a human body.  I'm aware that we all like to get misty-eyed about the incredible beauty of this miraculous event blah blah - I did it a little myself a few posts ago.  But if you step away from it and just look at what's happening physiologically, you're passing a huge object out of an opening that (in a primipara) has to stretch to a size it's never been before, and to make matters worse orient it in such a way that it passes through the MOST STUPIDLY-SHAPED HIPBONE IN THE NATURAL WORLD.  Childbirth is beautiful, yes.  It is also hugely traumatic, in the dictionary sense of the word.  If the analogy between childbirth and a root canal fails it is only because childbirth is more dangerous (according to several thousand years of human experience) and more painful (according to my wife).

Second, a few people on this thread have made reference to women's bodies being not just natural but 'designed'.  This is a misunderstanding of how evolution works.  Over hundreds of thousands of years (and probably tens of thousands of generations), evolution has blindly stumbled, through random mutation, on a geometry for human bodies that allows huge-headed babies to come out of the womb (barely) while still preserving the ability of women to run, upright, presumably to avoid being eaten by bears.  The only thing that this means is that more women with this body geometry managed to reproduce than women with other body geometries.  For all we know, there were mutations for women with much larger hip-bone interiors that gave birth more easily, and more successfully, but then who were devoured by bears moments after birth, or sometime thereafter.  The only thing that matters, evolutionarily, is that enough women were able to reproduce.  A huge number of women could (potentially) die during childbirth, and evolution would happily skate on, blissfully unaware, as long as those who lived could reproduce.  This is why whenever I see the word 'design' in these threads, my eye twitches.  According to the best studies I could find, the 'natural' maternal death rate is estimated at about 1500 per 100,000 births.  That's a death rate of over 1%.  That's a pretty lousy design.  If there was a 1.5% chance you'd die every time you got in a car, you'd never get in it.

Fortunately, thanks to modern medicine, the actual modern Western death rate is more like 9 in 100,000, according to the WHO.  In Sub-Saharan Africa, which is rich with folk-wisdom and midwives, but lacking in medical supplies, the death rate is 900 in 100,000.  Let me say that again in another way: when modern medicine isn't available to assist with childbirth, the death rate is two orders of magnitude higher.  So although we can all agree that "birth isn't a sickness!" I actually don't agree with the assessment that "birth isn't a medical event", because we have good statistics, gathered today, that tell us that without medical expertise - which doesn't necessarily mean provided by an O.B., mind you, Certified Nurse Midwives have great results in studies, for example -  it's a hugely risky medical event.

Lastly, I need to say something about the "cascade of unnecessary interventions".  The problem is that there is a fundamental misunderstanding, in this country at least, about what the job of a doctor is.  We all think (and I used to think this way too) that a doctor is a woman or man in a white lab coat who runs a lot of tests and then figures out what is wrong with you by looking through a microscope.  Maybe there's something completely new wrong with you - that's ok!  The doctor will figure it out!  Likewise, if you're pregnant, the doctor will look at you and just be able to tell "A-ha!  Your blood-pressure is X, and your skin tone is Y, this means that you are just beginning to go into pre-eclampsia! TO THE HOSPITALMOBILE, we will save you!"

I'm here to tell you that you are wrong about what doctors do.

What doctors know is statistics and how to use them.

With many syndromes in pregnancy, by the time there are obviously visible symptoms, it is often too late to save the baby; pre-eclampsia is a great example of this (disclaimer: i am not a doctor, and i don't actually know anything about pre-eclampsia.  I'm just using this as an example of the sort of analysis you'd prefer to do before there is an acute problem).  The analysis is statistical.  Does the patient have risk factors for pre-eclampsia?  Well, let's see.  Her mother had pre-eclampsia in a pregnancy.  This is her first pregnancy, and she's 18, obese, gets frequent migraines, and has gestational diabetes.  Based on the totality of those factors, this patient has X% of developing pre-eclampsia.

In walk two patients, Alice and Betty.  Alice and Betty, let's say, present with the exact same medical histories and yield the same statistical chance of developing pre-eclampsia.  Let's make it easy and say it's a 50% chance.  Either one (or neither) of Alice or Betty might get pre-eclampsia and lose their babies or their lives.  No doctor in the world can tell which one of them it will be.  All they can tell you is that, statistically, half of the patients with these symptoms end up in pre-eclampsia.  Thus, since 50% is a really, really huge chance when lives are on the line, the doctor will probably recommend extremely frequent examination coupled with early induction or c-section at the first wisp of trouble.

The thing about statistics and probability is that the statistics are only meaningful before the outcome is revealed.  This is super-hard for non-mathematicians to understand, but it's true.  If you flip a fair coin, you have a 50% chance of getting heads.  If you look at the coin, and it's tails, it's nonsensical to say "well, I might still get heads half the time I look at this coin."  Once you've looked at that coin, the chance of it being tails is 100%, and the chance of it being heads is 0%.  A proper statistical analysis is about future events.

The 'Unnecessary cascade of interventions" language is all about proving, after the fact, that the coin was tails so therefore the interventions were not needed.  But just because the coin happened to turn out to be tails does not mean that before we knew the outcome the 50% chance of it being heads didn't exist.  Analogized a different way: just because you arrived at your destination safely doesn't mean that there wasn't risk from being in the car with a drunk driver.  Yes, sometimes a doctor can look at an X-ray, and say "Welp, your arm is broken.  Let's put a cast on it."  But more often, particularly in pregnancy, all they can do is say "Other women with your presentation had this good outcome X% of the time, and this bad outcome Y% of the time.  My medical opinion is that we should do (some intervention) to try to avoid the bad outcome, because I think Y is a big number."

Anyway, I've gone far afield from the topic here.  But I just wanted to address some of these points because I see this language all the time, and I think it does everyone a disservice when we fail to remember that medicine is, by and large, about understanding and applying probability and statistics.  Mothers (and, more generally, patients) always have the right to make their own decisions about whether to accept or refuse treatment.  But I think it's important to do that from a position of knowledge, based on data and an understanding of probability and statistics, rather than a position of weakness, based on intuition and superstition.

First I would like to thank you for the good discussion, Sympathetic Dad.

I do not share your wife's experience, not even a little bit. I did not find either of my births to be hugely traumatic, either during or after, and certainly not more painful than a root canal. When breastfeeding my first baby for the first month, we had problems getting a good latch. That painful latch was by FAR more painful than my labor or birth of said baby. Like I mentioned earlier, the pain of labor, for ME, was very very intense, but so far removed from any other type of "pain" I've experienced in my life that I'm not even sure that "pain" is the right word. With my second baby, I did not experience pain, at all. Well, it was a little painful after she was born, waiting for the placenta to come, but that was it. (Hypnobabies FTW.) Obviously this is a highly subjective experience.

I do not deny that birth is an uncertain event, and some scary things can happen. I don't deny that it's a major physical event that there's really no other comparison to, in the scope of all other human physical events. I don't deny that some women will require medical assistance when giving birth, and I'm not suggesting those women should forego it and just let themselves or their babies die. I think it's interesting that you found the rate of maternal death in nature to be about 1%, and The Farm Midwives' c-section rate is about 1.5%. It seems they are doing it right, then. The rate of maternal death in nature is certainly not 33%, can we agree on that?

I find your implication that I (and others) don't understand what doctors do, or how they use statistics, or how the application of statistics works in real life, very insulting. In fact, I arrived at my very strong feelings on these matters through extensive research and reading about birth-related statistics, and through my studies developed an understanding of what factors contribute to successful birth outcomes. In the U.S. (I assume you're in the U.S. like me?) OBs as a whole do NOT base their practices on what is likely the best thing for the mother and baby. It's not because they're malicious.

It's because most of them do not even have an understanding of the natural process of birth. Most of them are not shooting for the goal of "most straightforward, complication-free birth." Because OBs do not specialize in birth, they specialize in *surgical* birth. They are also covering their own asses, so are not willing to wait and see if the woman is fine on her own before intervening--they think it safer, certainly for themselves, and I think they often *believe* for the mother/baby, to practice "defensive medicine," using interventions as preemptive measures rather than as *necessary* measures. It's an important distinction. Even the slightest *possibility* of risk means they will take action immediately. Trigger-happy doctors hurt women and babies.

Most first-time moms in this country get epidurals because 1) they are scared because they assume the pain will be unbearable, 2) they are probably unaware of the very real risks of an epidural and 3) most doctors love epidurals because it makes it easier for the doctors. As the OB, when you take away the unpredictability of a woman's natural labor, you also take away your risk of malpractice suit--at least, that's what they're thinking. When you monitor the woman and baby excessively--never mind that by doing that you may *cause* things to go wrong--nobody can claim you didn't do everything in your power. As a side bonus, you don't have to wait around if she's taking too long and inconveniencing you. You can just label her as "failure to progress" and apply more interventions until you force that baby out on your own terms. (I'm sorry if I sound cynical. Don't dismiss everything I'm saying just because I have a 'tude.)

Add to that the fact that the majority of OBs arrived at certain practices NOT because they have looked at the statistics and probabilities but simply because that's what they were taught and what everyone else does. Episiotomy is a case in point. Totally unnecessary close to 100% of the time. Almost *always* causes more damage than the *hypothetical* *possible* natural tear that would have happened. Often results in long-term complications and suffering. Seriously, nobody should practice this anymore. But they still do, in huge numbers. Just one reason amongst many that hospitals are not currently a safe place for low-risk women to labor and birth.

What you described: coming "from a position of knowledge, based on data and an understanding of probability and statistics," is EXACTLY what I did when making decisions about my children's births, and it is THE main reason I chose natural birth.

Of course I used my intuition as well--I think dismissing the value of one's intuition about what is happening in one's own body is extremely foolish. Listening to your intuition about your body does not equate to superstition or weakness.

Something that most people in our culture do not understand, especially men (understandably so, as they have no first-hand experience being pregnant or birthing) is how extremely important the mind-body connection is during pregancy and birth. I mean, it is an absolutely crucial factor, one of the primary factors, in how a woman's birth plays out. Please don't misunderstand me--I am not suggesting that the other factors are not also crucial (like whether her particular body is able to give birth unimpeded, or whether unforeseen complications arise, or whether those around her are providing support or causing her extra problems.) But how fearful you are, how much your guard is up, whether or not you believe you can do it, all those things have a HUGE effect on how you enter the experience and on your outcome. If you feel you are prepared, and if you feel you are safe and supported, all the energy you would've put towards worry and fear is now available to put towards inner focus. If you think inner focus has nothing to do with labor, it's only because you've never been in labor.

Are you familiar with "sphincter law?" Even just having a stranger in the room can impede a woman's labor significantly.

If you are interested in learning more about how a woman could come to be strongly in favor of natural birth through rational information-seeking, intelligent behavior (as opposed to "weakness and superstition") I suggest you do some more research. Michel Odent, Ina May Gaskin, and Henci Goer are a good place to start.

Edited by artekah - 8/20/12 at 11:36am