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Dec 14, 2009

Rethinking Birth

The study at Karolinska focused on the white blood cells in the umbilical cords of Caesarean babies and found mutations in their genetic makeup. The researchers noted differences in DNA sequencing of babies delivered via Caesarean and those delivered normally. —The Swedish Local

For most of human history, the two primary causes of premature death have been traumatic injury and infectious disease. Mainstream American medicine, with its heavy emphasis on hardcare practices, grew out of the challenge to solve these two problems. To a great extent it succeeded, with at times miraculous results. Yet the development of hardcare — a combination of complex diagnostic technologies followed by treatments of drugs and/or surgery — has come with unintended consequences that have brought American society to a profound crisis.

Hardcare medicine creates a specialized class of experts to administer to the sick while diminishing individual responsibility for the health of one’s body and mind. Hardcare drugs and surgeries can cause serious side-effects, often worse than the symptoms they attempt to cure. Hardcare treatments prove inadequate against a host of modern illnesses, yet hardcare tends to deny and actively campaign against other healing approaches. Finally, hardcare medicine is extremely expensive and thus exacerbates all of our current economic difficulties.

The failings of hardcare medicine have arisen where it has over-reached its ability and over-stated its role within society. Though hardcare medicine provides excellent tools for dealing with the problems of traumatic injury and infectious disease, it fails terribly for most other health problems.

Curing Birth

Risky labor inductions for “convenience” and all the complications associated with them–increased risk of prematurity, C-section, bladder and bowel injury, and maternal death–are now on the rise all over the country. It troubles me that more women don’t realize that a Cesarean section is major surgery. And it carries with it a risk of maternal death that is five to seven times greater than a normal birth. —Christiane Norrthrup, OB/GYN

Nowhere is the hammer of hardcare medicine more recklessly applied, and with such dire consequences, than in the practice of modem American obstetrics. Though most obstetricians are well-intentioned and extensively trained, to the extent that they follow hardcare practices (not all obstetricians do) their chosen tools are inappropriate for 90-95% of the births they oversee.

Hardcare obstetricians approach pregnancy/birth as if it were a life-threatening illness demanding invasive, high-tech intervention. Thus, while birth can be the most natural and sacred of life processes, hardcare medicine turns it into a messy female problem to be fixed. While birth can unfold as awe-inspiring theater, co-authored by the mother, infant, midwife, father and other supporters, hardcare turns it into a futuristic thriller, starring the doctor, and featuring the very latest in techno-controls. And though birth can be a joyful initiation into the human family — Welcome, child, to a world of love and absolute nurturance — American obstetrics turns it into a mechanical, impersonal, and too often violent medical emergency.

Because hardcare medicine diminishes individual responsibility for bodily processes, hardcare-conditioned women typically turn birth over to their doctors. Such women can be sadly uninformed about the nature of pregnancy and about the purpose of and ways to a fulfilling labor. They tend to let the doctors take care of everything, including time of delivery, drugs for the pain, and surgery if labor goes on too long. Unfortunately, the more that women cede responsibility for their bodies and birthings, the more problematic birth becomes, and the more necessary are the “birth-improving” interventions of hardcare medicine.

Well-Intentioned Interventions

Using an obstetrician for normal birth is like using a pediatrician as a babysitter.—birthing specialist Marsden Wagner

Hardcare interventions into birth begin with the mistaken notion that we can expect, and even schedule, birth to happen at a certain time. If it’s late getting started, then the obstetrician may use drugs to induce labor.

If we expected a rose to bloom on a certain day and then tried to pry it open with pliers when it was “late,” it would not surprise us that the flower would turn out poorly. Nor should it surprise us that chemically-induced labors often progress poorly — the mother/infant was not ready. (The ultimate perversion is caesarian deliveries scheduled according to hospital and doctor needs.)

Once labor begins, most American hospitals now require high-tech fetal monitoring. This consists of a wide belt wrapped around the mother’s waist and attached to a bedside machine that makes irritating noise throughout the labor. The belt prevents the mother from easily moving around according to her needs; it also prevents mother, father and midwife from placing their hands directly upon the lower belly or from massaging the lower back. All of this interference comes from a machine that has been proven in several studies to be of little if any benefit in most births. The main reason we continue to use fetal monitors — instead of non-invasive monitoring with a fetoscope — is so that doctors and hospitals have a record to refer to in the event of malpractice suits.

Other common interferences with labor include: the use of the counter-intuitive supine posture (rather than squatting); the lack of a well-informed labor supporter (simply having one such lay person, or doula, who stays with the mother throughout labor is of great benefit); the use of sterile, medical environments for labor and delivery; and the use of statistical norms to judge and direct the mother’s progress. All such interventions and interferences ultimately lead to a poorly progressing labor and, in reaction, to more invasive interventions.

In such cases the obstetrician might perform an episiotomy — surgically cutting the perineum to widen the mother’s vagina. Or might use forceps to mechanically pull the infant down the birth canal. Or might forgo labor and perform a caesarian delivery. (Roughly 33% of American births are now caesarians. This compares with 9% in Japan and Scandinavian countries.)

However the baby makes it out of the womb, we can expect further interventions. Doctors may cut the umbilical cord prematurely — before the baby has initiated breathing — leading to the classic abuse of hanging the infant upside down and slapping it. The infant will most likely be needle-poked three or four times during the first hour of its life (one or two blood tests, a vitamin K shot, and a hepatitis vaccine). The infant might be separated from its mother and placed alone in a nursery (especially if the mother is less than conscious due to drugs and/or surgery). And the infant might be fed ersatz formula food (hospitals and obstetricians have financial incentives to discourage breastfeeding.)

Obviously, all such interventions have been developed with the best of intentions — birth is risky, it sometimes goes poorly, and hardcare practitioners work hard to keep the mother and baby alive and relatively healthy. Yet studies of births in other countries, combined with studies of midwife-directed births in America, show that for more than 90% of births, obstetrical interventions do more harm than good.

The Damage Done

In 1979, [California] appropriated $750,000 for the first scientific study ever made of the root causes of violence. Two years later a first paper was issued, listing the ten principle causes of crime and violence in our nation. At the top of the list was the violent way we bring our children into the world. —Joseph Chilton Pearce

Harm to the mother can include various side-effects from drugs and surgery, and a further diminishing of her sense of responsibility for body and life. Harm to parents and child includes the medicalizing and mechanical-demeaning of what could have been a profound life experience. Harm to society includes vast amounts of unnecessary anguish and expense.

But it is the babies who suffer most, though hardcare practitioners say otherwise. They claim that babies are unaffected by the events of birth and early childhood. Babies don’t remember, we are assured. The infant born into a cold, brightly-lit room staffed with masked technicians; the infant who is slapped while choking for breath; the infant who is poked, jabbed, weighed, measured and then separated from its mother; the infant boy with the foreskin of his penis sliced off: it doesn’t matter, the experts assure us, babies don’t remember.

It is the grossest of misunderstandings, a terrible foolishness, for which we pay dearly. Humans are conscious, growing, learning and developing from day one. Babies are influenced, positively or poorly, by each and every human interaction. To cause unnecessary physical or emotional pain to an infant is child abuse, plain and simple. To do so under the rubric of “good medicine” is a continuing nightmare from which America must awaken soon.

Power to the Midwives

Studies have repeatedly shown that in healthy mothers with no risk factors, home birth is as safe as hospital birth. Increasingly, savvy women who trust their ability to birth normally are opting to avoid the hospital altogether (or at least have the foresight to hire a midwife or doula). —Christiane Norrthrup, OB/GYN

Fixing birth is so simple: pass a federal law mandating power, status and privilege to the softcare practices of well-trained midwives. Hardcare obstetricians can carry on as they have, for parents who want such deliveries, and for the small percentage of pregnancies that present as high-risk situations. But for those who desire safe, natural, and joyful births, let midwifery become a socially-supported option. Take away the legal and financial barriers that now impede midwives throughout America, and let pregnant women choose.

The return of midwifery will give us healthier children and mothers and will save us a lot of money in the process. Moreover, if the first step in our healthcare system is positively transformed, the rest might naturally follow.

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