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Tuesday, April 26, 2011

Home Birth—Why It's Necessary {By Ina May Gaskin}

(Originally published by Ina May Gaskin Productions, 2007-01-14)

Simply put, when there is no home birth in a society, or when home birth is driven completely underground, essential knowledge of women’s capacities in birth is lost to the people of that society—to professional caregivers, as well as to the women of childbearing age themselves. The disappearance of knowledge once commonly held paves the way for over-medicalization of birth and the risks which this poses. Nothing in medical literature today communicates the idea that women’s bodies are well designed for birth. Ignorance of the capacities of women’s bodies can flourish and quickly spread into popular culture when the medical profession is unable to distinguish between ancient wisdom and superstitious belief. To illustrate, I would cite a National Geographic article (1) which states that, “…we [humans] can give birth to babies with big brains, but only through great pain and risk.” The writer, depending upon the work of two U.S. anthropologists, explains that the fact that our species walks upright causes inevitable pain and risk during birth, forgetting how easily we can go to our hands and knees if need be.
I would have had no way to know how well healthy women’s bodies can work in labor and birth had I not experienced a rediscovery of women’s capacities in birth, along with several hundred other people, as we established a midwifery service in our newly founded community in 1970. Most people would have predicted that my diving headlong into attending home births for friends and then training a group of midwives to work with me would have ended in disaster, given that I came into midwifery only with the training afforded by two degrees in English literature. What happened instead is that I received timely and essential help from a few generous, wise physicians, and our service was able to help the first 186 women give birth vaginally (without instruments or other medical interventions) before our first cesarean was necessary. It was not until birth #324 that the second became necessary. All of this was accomplished without negative consequences to mothers or babies.
This degree of success is hard for many physicians to believe, because it runs counter to what they have been taught. For many decades, physicians have been taught that the female pelvis is often too small to permit the safe passage of a term baby through it. Still, over the last three and a half decades, more than 2400 births have been attended within our midwifery service, with our cesarean and instrumental delivery rates combined still below 2 percent, in sharp contrast to the U.S. cesarean rate, which is now nearly 30 percent and climbing.
The publication of our early data in my first book, Spiritual Midwifery, in 1975, helped to encourage the natural childbirth movement that began in North America during the late 1960s. (2) This movement caused U.S. hospitals to radically reassess their maternity care policies during the 1970s and 1980s, leading them, for the first time, to allow family members to be present at births; to allow women, for the first time, to choose midwives as birth attendants; and to change—again for the first time, their policy of mandatory episiotomy. The natural childbirth movement, which was greatly inspired by home birth pioneers, also had the effect of drastically reducing the incidence of forceps deliveries, which had previously been used in more than 40 percent of U.S. births.
Midwifery care blossomed in the U.S. because of the home birth movement, as women who didn’t themselves want home births but who did want care that did not involve routine and unnecessary medical interventions and practices, such as pubic shaving, enemas, being forced to remain still while lying supine during labor (the painful position possible) and often mandatory pain medication, wanted to be able to choose the midwifery model of care in the hospitals where they would give birth. Women themselves began to force these changes by opting for midwifery care and by insisting upon doula care. All of these transformations demonstrated both to laboring women and to their caregivers that women are fully capable of giving birth without the mandatory use of several interventions once considered by U.S. obstetricians to be not only important but essential to the health of mother or baby.
I have not yet mentioned the long list of techniques and practices common to home birth midwifery, which have made their way into progressive hospital maternity care practice. Among these are the use of water tubs for alleviation of pain during labor, the all-fours position (sometimes called the Gaskin maneuver) to resolve the serious complication of shoulder dystocia (3-5), upright positions for labor and birth, the safety of allowing almost all women to enter labor without induction, the use of nipple stimulation to release the body’s natural oxytocin to augment labor (6,7) and the possibility of sleeping, eating and drinking during labor. It is no exaggeration to say that none of these techniques would have been adopted into hospital practice, had it not been for their having first been developed and tested in the “laboratory” of home birth practice. Medical research is expensive and thus rarely focuses on preventive measures or those which don’t rely upon pharmaceutical or technological products.
Another extremely important concept that arises from home birth practice is the recognition of what I call “sphincter law.” (8) This concept describes the common phenomenon, which occurs often in women’s labors, in which stress sometimes causes the cervix, once dilated in labor, to suddenly close, or for labor to stop. Having first observed this phenomenon in the early years of my practice, I found that other midwifery colleagues working in and out of hospitals and many labor and delivery nurses were also familiar with it. We found that such cases could safely resolve themselves, without medical intervention, by waiting for labor to resume in less stressful circumstances. Looking deeper into medical books written during the period when home birth was the norm, I found many 19th century authors who had also documented this physiological phenomenon, which is dependent upon an imbalance of maternal hormones during labor which can take place when the woman feels greatly stressed during the birth process. If current medical knowledge included these concepts which it once did, fewer women would be subjected to the risks of induction drugs, the use of which has increased sharply over the last fifteen years—not always with good results. (9)
Of course, this is not to say that women should be required to have home births. However, the option to give birth in the place of choice should be open to those women who desire it, as long as their physical condition permits it as a safe choice. The body of knowledge available to all maternity caregivers depends upon a full range of choices being available to childbearing women.
Notes
1. Ackerman J. The downside of upright. National Geographic July 2006, 126-145.
2. Gaskin IM. Spiritual Midwifery (1975) Summertown, TN: The Book Publishing Company.
3. Meenan A and Gaskin IM, et al. A new (old) maneuver for the management of shoulder dystocia, The Journal of Family Practice, 1991: 32:625-29.
4. Bruner J and Gaskin IM, et al. All-fours maneuver for reducing shoulder dystocia, The Journal of Reproductive Medicine, 1998; 43:439-43.
5. Gabbe SG, Niebyl JR, and Simpson JL. Obstetrics: Normal & Problem Pregnancies, 4th ed. New York: Churchill Livingstone, 2002.
6. Curtis P. A comparison of breast stimulation and intravenous oxytocin for the augmentation of labor, Birth, June 1999; 26:115-122.
7. Curtis P. Breast Stimulation to Augment Labor: History, Mystery, and Culture. Birth, June 1999; 26: 123-6.
8. Gaskin, Ina May. Understanding birth and Sphincter Law, British Journal of Midwifery, Volume 12, Number 9, September 2004.
9. Wagner M. Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First (2005) Berkeley, CA: University of California Press.

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