Last week I watched Pregnant in America. It was a good film, with a very similar message to The Business of Being Born. My brief summary would be that, often, decisions for labouring women are made because of expediency or the fear of litigation, without taking the mother’s desires into account. Statistics like the rising cesarean rate seem to indicate that birth is highly-medicalized in many cases, although I am in no position to speak authoritatively on this subject.
Watching movies like this, and reading natural birth articles and blogs, homebirth is often promoted as the remedy to problems that can occur in a hospital. Many of my friends have chosen homebirth, and were very happy with it. I think it can be a great option, and I believe that it is as safe as hospital birth when experienced help is on hand and medical care is nearby. I am glad to see homebirth advocates fighting for birthing women, and ensuring that they have a choice of care providers and birthing environment.
While I believe in natural* birth, I know that homebirth is not an option for everyone. My first child was born at 34 weeks, and so the only responsible choice was to head to the hospital. Approximately 1 in 8 babies are born prematurely in the US each year, which is not a small number. And while most health authorities agree that the cesarean rate is too high, even if we reduced it by half, more than 1 in 10 women would have a surgical delivery. Homebirth is not the first choice for most folks when things go well, either. It could just be personal comfort level, it could be that homebirth is illegal in their area, or it could be that medical insurance won’t cover it. Even finding a homebirth provider can be a challenge, as demand for midwives frequently exceeds their availability. One way or the other, people are going to end up giving birth in the hospital
Watching Pregnant in America I wondered, once birth becomes a medical event, is it possible to retain its humanity? No matter what the circumstances are, no matter how many machines are in the room or how many masked and gloved surgeons are on hand, this is still about a family welcoming a new member. You will remember the events that unfold and the things that people say for the rest of your life. When things don’t go well, when you’re vulnerable and scared, that is all the more true. I will never forget the nurse who chastised me for being in labour at 34 weeks. I’m sure that she didn’t mean harm, but her offhand remark stuck in my head, and the message that I was at fault is something I still carry with me.
As it turns out, I gave birth prematurely because I had an acute infection. Another consequence of that infection was that I hemorrhaged severely following my daughter’s birth. Had I given birth in 1805 instead of 2005, I would not have survived the experience. The combination of antibiotics, synthetic oxytocin administered after I gave birth to stop my bleeding, and a blood transfusion likely saved my life. Modern medical care certainly has its place in childbirth. But so do compassion and gentleness. A kind word, instead of an unkind one, will not compromise someone’s care, but it can make all the difference.
I fear that there is polarization in the way that we approach birth today. There are people who advocate for natural birth and reduced interventions, which are great things. But they are often at a loss in terms of how to address a situation once it has already been medicalized, particularly if that medicalization is necessary. Then there are people who want all the bells and whistles and pain medication and machines that go ping. Their message is about protecting the health of babies, which is also incredibly important, but it doesn’t always acknowledge the emotional and psychological dimension of birth. I wish that there were a larger middle ground between these polarities, because I suspect that’s where most mothers actually fall.
I don’t have good answers, and I wish I did. I do think that as progress is made and women make their desires known change can happen. I hope that it does, and that it happens in such a way that all birth options are protected, and all mothers are treated respectfully and thoughtfully in childbirth, no matter how or where they birth.
*I don’t particularly like the term ‘natural birth’ because it is ambiguous and somewhat loaded, but it was the best I could come up with, without heading off on a major tangent.