As long as our country continues to show up so poorly in world rankings on maternal health, I continue to run this article every year on America's birthday, hoping to illuminate issues around our perceived birth choices. Am I naive in thinking that individual independence around these issues can help pave the way to us being a safer nation for mothers and babies?

It is sad enough that the U.S. sits so poorly in world infant mortality rankings, but a new report published in the prestigious medical journal Lancet and reported in the Washington Post points out that our childbirth-related maternal death rate continues to rise and is at nearly its highest point* in twenty-five years. [*Aside from its sharp spike in 2009 due to the H1N1 influenza virus.] American mothers die in or around childbirth at double the rate they do in Saudi Arabia, and triple the rate of the United Kingdom -- and at statistically the same rate as in Iran.

In terms of where it is safest and healthiest to become a mother, America -- land of the free and the brave -- ranks 60th of 180 nations. In that context, is there any real birth choice?

Okay, now that I've totally bummed you out so you feel like you've got to reach for an early margarita with a little flag in it, let's talk about what individual Americans may be able to do to improve the situation. (And even if it doesn't improve the national situation, it cannot help but to improve your own birthing and parenting wellbeing!)

Moms & Dads, Who Is The Boss of You?

4thOfJulyParadeAs we celebrate our nation's independence from oppressive rule, I want to explore a related kind of oppression you may experience all the time: the force of culture on birth and parenting choices. The fact is, the status-quo of today's culture -- media, medicine, education -- exerts tremendous pressure on well-meaning parents to make choices that simply aren't good for kids. This is where some knowledge can be a very empowering thing!

The more we know about where our decision-making "blind spots" are, the more we can free ourselves from the prevailing fear-based group-think, and become capable of making positive choices that are in the true best interests of ourselves and our children.

Are We Truly Free to Choose?

Let's begin where it begins -- how we ourselves are born, how we birth our children, and how we perceive the choices involved. Robbie Davis-Floyd, a cultural anthropologist specializing in birth, discovered something both subtle and powerful at work in our attitudes about the safety of non-medicalized births.

"I long ago gave up talking to women about giving birth at home," writes Robbie. (She's become a dear friend, thus I will call her by her first name, lol.) "The idea that only hospitals and their technology can make birth safe so permeates this culture that there is simply no point in trying to convince anyone otherwise, even though it is completely untrue and there is plenty of scientific evidence out there to prove it."

One piece of evidence to which Robbie refers is this classic: Back in 1974 two certified nurse-midwives were put in charge of all normal births in a small county hospital in California for three years in an experimental pilot program. During that time, the rates of obstetrical intervention (like C-sections) fell dramatically, the incidence of prematurity dropped by almost half, and the rate of neonatal deaths dropped from 23.9 per thousand to 10.3 per thousand -- less than half of what it had been before the midwives arrived. At the end of the three years (some say due to fear of competition) the local obstetricians fired the midwives and resumed charge of all births in this hospital. Within a few months, the rates returned to their former high levels.

In light of LOTS of research showing that routine interventions & procedures -- such as Pitocin augmentation, electronic fetal monitors, IVs in place of drinkingand eating, episiotomies and epidurals -- don't lead to better outcomes and are indeed counterproductive in most normal births, Robbie wondered, "What might explain the standardization and technological elaboration of the American birthing process?"

She came to recognize that there had to be something other than rational logic at work in the vast majority of Americans who trust and believe in the relatively higher degree of safety provided by a hospital birth, despite all contrary evidence. Her discoveries led to the landmark book Birth As An American Rite of Passage.

"In all societies, major life transitions such as birth, coming of age, marriage and death are times when cultures are particularly careful to display their core values and beliefs. Thus, these important transitions are so heavily ritualized that they are called rites of passage. Through these rites of passage, each society makes sure that the important life transitions of individuals can only occur in ways that actively perpetuate the core beliefs and values of their society. Could this explain the standardization of American birth? I believe the answer is yes."

Birth Choice, or Cultural Rite of Passage?

One characteristic of rite of passage rituals is that participants are in an altered state of mind, whether through music, drumming, dance, chanting, breath work, meditation, or mind-altering substances. In the case of labor and birth, the potent biochemicals flowing through mother and baby - and even father - are extremely mind-altering! Any of these kinds of altered states makes participants highly receptive to symbols, which are prominently featured during ritual and which are imprinted on the image-oriented right brain.

Robbie: "Obstetric procedures are far more than medical routines: they are the rituals which initiate American mothers, fathers and babies into the core value system of the technocracy" (the term for a society driven by an ideology of technological progress. In a technocracy, we constantly seek to "improve upon" nature by altering and controlling it through technology.)

LaboringWithEFMShe writes, "These procedures are profoundly symbolic, communicating messages concerning our culture's deepest beliefs about the necessity for control of natural processes. They are a perfect expression of certain fundamentals of technocratic life:
~ The IV, for example, is the umbilical cord to the hospital, mirroring the fact that we are all umbilically linked to the technocracy, dependent on society and its institutions for our nurturance and our life.
~ The fact that the baby's image on the ultrasound screen is often more real to the mother than its movement inside her reflects our cultural fixation on experience one-step removed on TV and computer screens.
~ The electronic fetal monitor wires the woman into the hospital's computer system, bringing birth into the Information Age.
~ Consider the visual and kinesthetic images that the laboring woman experiences -- herself in bed, in a hospital gown, staring up at an IV pole, bag and cord, staring down at a steel bed and huge belts encircling her waist and staring sideways at moving displays on a large machine. Her entire sensory field conveys one overwhelming message about our culture's deepest values and beliefs: technology is supreme, and you are utterly dependent upon it.
~ The episiotomy, in which the quite sufficiently stretchy perineum is routinely cut with scissors to speed up delivery of the head, enacts and displays not only our cultural tendency toward impatience but also our extreme commitment to the straight line as a basic organizing principle of cultural life.
~ The technocracy asserts societal ownership of our babies via the ritual separation of newborns and mothers shortly after birth (yet another procedure that is overwhelmingly contraindicated by over 50 years of research on attachment, trauma and brain development).
~ The plastic bassinet in which the newborn is placed metamorphoses into the crib, the playpen, the plastic carrier, and the television-set-as-babysitter-and a baby who bonds strongly to technology as she learns that comfort and entertainment come primarily from technological artifacts. That baby grows up to be the consummate consumer, and thus the technocracy perpetuates itself.
Yes, most of us have been baptized in technology. So let us embrace the blessings of that 21st century brilliance, which was originally meant to bring freedom! Nothing has the power to control our moves once we can clearly name the players and the game.

As we light up the skies in celebration of our independence as a country, let us fire up our own informed independence: let's be the bosses of ourselves, the masters of our own will. Our children will flourish in that freedom, and the healthy choices it allows us to make!

** Read more about Robbie Davis-Floyd's fascinating work at her website here. **

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