Who Con­trols Birth? Defin­ing the Argument.

Peri­od­i­cally, argu­ments arise in the birthing field over who con­trols the way we give birth. Often this hap­pens at times when birthing women change their behav­ior trends, putting finan­cial pres­sure on pro­fes­sion­als work­ing in this field. The major play­ers in this argu­ment are med­ical doc­tors (obste­tri­cians), cer­ti­fied nurse mid­wives and pro­fes­sional home birth midwives.

Cur­rently we are see­ing women leave the tra­di­tional hos­pi­tal set­ting for birth in larger and larger numbers…and tak­ing their dol­lars with them in the process. While the ques­tion of home birth safety arises every time this con­trol argu­ment comes around, the ques­tion of whether it is safe to inter­vene in a labor that is pro­gress­ing nor­mally is a new com­po­nent of the dis­cus­sion. This time the argu­ment is: The safety of home birth vs. the safety of using hos­pi­tal tech­nol­ogy to inter­vene in nor­mal birth.

How Money Affects this Issue

As with all com­mer­cial ven­tures, con­trol­ling access to safe birth requires con­trol­ling the infor­ma­tion in the mar­ket place. This infor­ma­tion needs to address the per­ceived wants of the tar­get audi­ence. For a long time the main mes­sage has been: Safe birth is only avail­able in a hospital.

The finan­cial pres­sure of giv­ing women (con­sumers) what they want — a nor­mal expe­ri­ence of birth in a safe set­ting where med­ical help can be quickly avail­able — has pow­ered the birth-center indus­try. Free-standing and in-hospital birth cen­ters have grown in num­bers, and are largely enabled by cer­ti­fied nurse-midwives. Mean­while, pro­fes­sional home birth mid­wives have increased both their cre­den­tials and prac­tice stan­dards, as well as their visibility.

Both of these options, birth cen­ters and home birth, threaten the liveli­hood of tra­di­tional obstet­ri­cal prac­tices. Low risk births (about 70% of births) have the poten­tial to be nor­mal births, requir­ing lit­tle or no inter­ven­tion. But, giv­ing birth in the hos­pi­tal means par­tic­i­pat­ing in mea­sure­ment pro­ce­dures that inter­vene in the labor process.

So, to con­vince women they need to be in a hos­pi­tal to be safe, med­i­cine has main­tained the argu­ment that home birth or out of hos­pi­tal birth is not safe. How­ever, research does not indi­cate this is true. The nature of this ongo­ing argu­ment is dis­cussed in a 2002 arti­cle from Mid­wifery Today.

What’s New? The Counter Argument.

The phys­i­ol­ogy of nor­mal labor is dom­i­nated by parasym­pa­thetic, med­i­ta­tive, gonadal energy sys­tems. Mea­sure­ment is a sym­pa­thetic, ratio­nal, adrenal energy dynamic. Only when it is time to expel the baby does the under­ly­ing energy sys­tem make a tran­si­tion (tran­si­tion, get it?) to an adrenal impe­tus for the strength activ­ity of push­ing. Imme­di­ately fol­low­ing nor­mal birth, mater­nal phys­i­ol­ogy is again dom­i­nated by gonad-driven energy along with a rush of endorphins.

“Inter­vene enough and things will go awry. You can eas­ily end up being cut and/or sep­a­rated from your baby at birth.” These ideas have gone viral. With the arrival of the inter­net, women have found a very quick way to do what we have always done: Share information.

Thus, in my exer­cise pro­gram and in my child­birth prepa­ra­tion classes, I have more and more fre­quently been field­ing the fol­low­ing ques­tion from women who want a nor­mal birth and want to be safe: “How can I avoid inter­ven­tions while I am in the hospital?”

So, I ask them what leads them to ask this ques­tion. And, they say: “I read on the inter­net and/or heard from my friends that inter­ven­tions make birth less nor­mal and less safe. I want to pro­tect myself.”

Women them­selves are enter­ing the argu­ment in a much more con­scious way than in the past. Some pro­fes­sion­als would like to keep women out of the argu­ment. But, like with many things in our 21st cen­tury world, we have already past the point of no return. As they say, the horse has already left the barn!

Word has got­ten around. More and more, as a pre­na­tal fit­ness expert who strives to lis­ten to my clients, my job has become edu­cat­ing and phys­i­cally train­ing women to cope with a stren­u­ous and prim­i­tive process in a tech­no­log­i­cal world.

Hope­fully, we can all keep our eye on the ball here. Pre­vent­ing trauma should be one key goal. Just as we have learned to hold our new­borns skin to skin so they can smell and taste us, lis­ten to our heart beat and voice, and main­tain their core tem­per­a­ture, let us learn to com­fort and nur­ture our new moth­ers, while we steel them for the rig­ors of birth.